Outcomes and Biochemical Parameters Following Cardiac Surgery: Effects of Transfusion of Residual Blood Using Centrifugation and Multiple-Pass Hemoconcentration

Published:August 28, 2013DOI:https://doi.org/10.1053/j.jvca.2013.03.011


      To determine whether or not there was a significant difference between the methods of centrifugation (CF) and multiple-pass hemoconcentration (MPH) of the residual cardiopulmonary-bypass volume in relation to biochemical measurements and patient outcomes.


      Prospective, randomized, and controlled.


      Conducted at a western Canadian tertiary care hospital.


      Consisted of 61 consecutive male and female patients from ages 40 to 80 who were scheduled for cardiac surgery with cardiopulmonary bypass.


      Either the centrifugation or multiple-pass hemoconcentration method was used to process the residual blood from the cardiopulmonary bypass circuit.


      The 12-hour postoperative levels of serum hemoglobin were not significantly different in the centrifugation group as compared to the multiple-pass hemoconcentration group. However, the serum levels of total protein and albumin were significantly higher in the multiple-pass hemoconcentration group as compared to the centrifugation group. Additionally, after 12-hours postoperatively, the serum fibrinogen and platelet counts were significantly higher in the multiple-pass hemoconcentration group as compared to those of the centrifugation group.
      The allogeneic product transfusion index and the chest-tube blood drainage indices were lower in the multiple-pass hemoconcentration group as compared to the centrifugation group.


      Although the CF method provided a product in a shorter turnaround time, with consistent clearance of heparin, the MPH method trended towards enhanced biochemical and clinical patient outcomes over the 12-hour postoperative period.


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        • Roger VL
        • Go AS
        • Lloyd-Jones DM
        • et al.
        Heart disease and stroke statistic update: A report from the American Heart Association.
        Circulation. 2012; 125: e2-e220
        • Hajjar L
        • Vincent JL
        • Galas FRBG
        • et al.
        Transfusion requirements after cardiac surgery. The TRACS randomized controlled trial.
        JAMA. 2010; 304(14): 1159-1567
        • Marik PE
        • Corwin HL
        Efficacy of red blood cell transfusion in the critically ill: A systemic review of the literature.
        Crit Care Med. 2008; 36(9): 2667-2674
        • Kleinman S
        • Chan P
        • Rollibard P
        Risks associated with transfusion of cellular blood components in Canada.
        Transfusion Med Rev. 2003; 17(2): 120-162
        • Ham SK
        • Waters JH
        • Lynn P
        • et al.
        Changes in mechanical fragility and free hemoglobin levels after processing salvaged cardiopulmonary bypass circuit blood with a modified ultrafiltration device.
        J Extra Coropor Technol. 2012; 44: 21-25
        • Wang G
        • Bainbridge D
        • Martin J
        • et al.
        The efficacy of an intraoperative cell saver during cardiac surgery: A meta-analysis of randomized trails.
        Anesth Analg. 2009; 109: 320-330
        • Sutton RG
        • Kratz JM
        • Spinale FG
        • et al.
        Comparison of three blood-processing techniques during and after cardiopulmonary bypass.
        Ann Thorac Surg. 1993; 56(4): 938-943
        • Sandoval S
        • Alrawi S
        • Samee M
        • et al.
        A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery.
        Heart Surgery Forum. 2001; 4(2): 113-117
        • Amand T
        • Pincemail J
        • Blaffart F
        • et al.
        Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit.
        Perfusion. 2002; 17: 117-123
        • Engelhardt W
        • Blumberg D
        Risks and side effects of intraoperative autotransfusion.
        Beitr Infusionsther. 1991; 28: 317-321
        • Roeder B
        • Graham S
        • Searles B
        • et al.
        Evaluation of the Hemobag: A novel ultrafiltration system for circuit salvage.
        J Extra Corpor Technol. 2004; 36(2): 162-165
        • Samolyk KA
        • Beckmann SR
        • Bissinger RC
        A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: The Hemobag.
        Perfusion. 2005; 20(6): 343-349
        • Stammers AH
        • Morrow JF
        • Brady CP
        • et al.
        Ultrafiltration of the waste plasma effluent from cardiopulmonary bypass circuit contents processed with a cell-washing device.
        J Extra Corpor Technol. 1996; 3: 134-139
        • Tamari Y
        • Nelson RL
        • Levey RS
        • et al.
        Effects of hemoconcentrator on blood.
        J Extra-Corpor Technol. 1984; 16(3): 89-94
        • Boldt J
        Use of Albumin: An update.
        Br J Anaesth. 2010; 104(3): 276-284
        • Finfer S
        • Bellomo R
        • Boyce N
        SAFE Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
        N Engl J Med. 2004; 350: 2247-2256
        • Friedman G
        • Jankowski S
        • Shahla M
        • et al.
        Hemodynamic effects of 6% and 10% hydroxyethyl starch solutions vs. 4% albumin solution in septic patients.
        J Clin Anesth. 2008; 20: 528-533
        • van der Heijden M
        • Verheij J
        • van Nieuw Amerongen GP
        • et al.
        Crystalloid and colloid fluid loading and pulmonary permeability, edema, and injury in septic and non-septic critically ill patients with hypovolemia.
        Crit Care Med. 2009; 37: 1275-1281
        • Journois D
        Hemofiltration during cardiopulmonary bypass.
        Kidney Int Suppl. 1998; 66: S174-S177
        • Journois D.
        • Pouard P
        • Greeley W
        • et al.
        Hemofiltration during cardiopulmonary bypass in pediatric surgery.
        Anesthesiology. 1994; 81: 1181-1189
        • Delaney E
        • Rosinski D
        • Ellis H
        • et al.
        An in-vitro comparison between Hemobag and non-Hemobag ultrafiltration methods of salvaging circuit blood following cardiopulmonary bypass.
        Extra Corpor Technol. 2010; 42(2): 128-133
        • Robertshaw M
        • Lai KN
        • Swaminathan R
        Prediction of creatinine clearance from plasma creatinine: Comparison of five formulae.
        Br J Clin Pharmacol. 1989; 28: 275-280
        • Beckman SR
        • Carlile D
        • Bissinger RC
        • et al.
        Improved coagulation and blood conservation in the golden hours after cardiopulmonary bypass.
        JECT. 2007; 39: 103-108
        • Apelgren KN
        • Rombeau JL
        • Twomey PL
        • et al.
        Comparison of nutritional indices and outcomes in critically ill patients.
        Crit Care Med. 1982; 10: 305-307
        • Bradley JA
        • Cunningham KJ
        • Jackson VJ
        • et al.
        Serum protein levels in critically ill surgical patients.
        Intensive Care Med. 1981; 7: 291-295
        • Murray MJ
        • Marsh HM
        • Wochos DN
        • et al.
        Nutritional assessment of intensive care unit patients.
        Mayo Clinic Proc. 1988; 63: 1106-1115
        • Fleck A
        • Hawker F
        • Wallace PI
        • et al.
        Increased vascular permeability: A major cause of hypoalbuminemia in disease and injury.
        Lancet. 1985; 1: 781-784
        • Hu M
        • Louise S
        • Cross CE
        • et al.
        Antioxidant protection against hypochlorus acid in human plasma.
        J Lab Clin Med. 1993; 121: 885-892
        • Sun X
        • LLes M
        • Weissman C
        Physiological variables and fluid resuscitation in the postoperative intensive care patient.
        Crit Care Med. 1993; 21: 555-561
        • Kitchen S
        • Machin SJ
        • Lowe GD
        • et al.
        Guidelines on fibrinogen assays.
        Br J Haematol. 2003; 121(3): 396-404
        • Verheij J
        • Linger A
        • Raijmakers P
        • et al.
        Effect of fluid loading with saline or colloids on pulmonary permeability, edema, and lung injury score after cardiac surgery.
        BJA. 2006; 96: 21-30
        • Wernovsky G
        • Wypij D
        • Jonas RA
        • et al.
        Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: A comparison of low flow cardiopulmonary bypass and circulatory arrest.
        Circulation. 1995; 92: 2226-2235
        • Gruenwald CE
        • McCrindle BW
        • Crawford-Lean L
        • et al.
        Reconstituted fresh whole blood improves clinical outcomes compared with stored component blood therapy for neonates undergoing cardiopulmonary bypass for cardiac surgery: A randomized controlled trial.
        J Thorac Cardiovasc Surg. 2008; 136(6): 1442-1449
        • Kulik TJ
        • Moler FW
        • Palmisano JM
        • et al.
        Outcome-associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery.
        Circulation. 1996; 94(9 Suppl): II63-II68
        • Rhodes JF
        • Blaufox AD
        • Seiden HS
        • et al.
        Cardiac arrest in infants after congenital heart surgery.
        Circulation. 1999; 100(19 Suppl): II194-II199
        • Gaies MG
        • Gurney JG
        • Yen AH
        Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass.
        Pediatric Critical Care Medicine. 2010; 11(2): 234-238
        • Sasser WC
        • Robert SM
        • Waldemar CF
        • et al.
        Postoperative serum cortisol concentration and adrenal insufficiency in neonates undergoing open-heart surgery.
        World Journal for Pediatric and Congenital Heart Surgery. 2012; 3: 214-220
        • Davidson J
        • Hancock H
        • Hauck
        • et al.
        Prospective validation of the vasoactive inotrope score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery.
        Intensive Care Med. 2012; 38(7): 1184-1190
      1. Grant SW, Hickey GL, Dimarakis I, et al: How does the EuroSCORE II perform in UK cardiac surgery? An analysis of 23,740 patients from the Society for Cardiothoracic Surgery in Great Britain and Ireland National Database. Heart doi:10.1136/heartjnl-2012-302483, 2012

        • Coli A
        • Balduzzi S
        • Ruyra X
        The Hemobag: The modern ultrafiltration system for patients undergoing cardiopulmonary bypass.
        J Cardiothorac Surg. 2012; 7: 551-556