Impact of an Autotransfusion Device on Platelet Count and Transfusion Requirements in Cardiac Surgery: An Observational Study.

OBJECTIVES

To compare postoperative platelet counts in patients in whom intraoperative cell salvage (ICS) was performed using either a centrifugation-based device (ICS-centrifugation) or a filtration-based device (ICS-filtration; Same) for red blood cell recovery from shed blood, as well as to compare the transfusion requirements and outcomes of the patients in both groups.

DESIGN

Observational, retrospective, single-center study.

SETTING

Academic hospital, June 2021 to May 2024.

PARTICIPANTS

All patients admitted for scheduled cardiac surgery who had an anticipated duration of cardiopulmonary bypass ≥ 2 hours or underwent aortic arch surgery, redo or combined surgery, or multiple aorto-coronary bypasses, who had expressed their non-opposition to the use of their personal data for research purposes and for whom data collection was performed.

INTERVENTIONS: Red blood cell recovery from shed blood with either the ICS-centrifugation device (n = 208) or the ICS-filtration device (n = 85) according to device availability.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the decrease in platelet count between the preoperative and postoperative assessments. Secondary outcomes included transfusion rate, postoperative morbidity, and length of hospital stay. A total of 293 patients were included, predominantly male (81.6%); the mean age was 66.2 years. Postoperatively, the platelet count decrease was greater in the ICS-centrifugation group than in the ICS-filtration group (74.9 × 109/L v 65.0 × 109/L; mean difference, 9.94 [95% confidence interval, 1.99-18.58]; p = 0.02). This difference was consistent in the multivariable analysis. The number of patients receiving intraoperative or postoperative transfusion by day 28 was higher in the ICS-centrifugation group than in the ICS-filtration group (49% v 34.1%, p = 0.03). Finally, the ICS-centrifugation group presented higher overall postoperative morbidity rates than the ICS-filtration group on day 28 (16.3% v 5.9%; odds ratio, 0.32 [95% confidence interval, 0.11-0.78]; p = 0.03).

CONCLUSIONS

Compared with ICS-centrifugation, ICS-filtration may offer advantages in platelet salvage for shed blood, thereby reducing transfusion requirements and related morbidity in cardiac surgery patients. These results need to be confirmed by larger randomized studies with a special focus on clinical outcomes.