[en] Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another.
McBride W.T., McBride S.J. (1998) The balance of pro- and anti-inflammatory cytokines in cardiac surgery. Curr. Opin. Anaesthesiol 11:15-22.
Casey L.C. (1993) Role of cytokines in the pathogenesis of cardiopulmonary bypass-induced multisystemic organ failure. Ann. Thorac. Surg 56:92-96.
Courtney J.M., Sundaram S., Matata B.M., Gaylor J.D.S. (1994) Bio-materials in cardiopulmonary bypass. Perfusion 9:3-10.
Defraigne J.O., Pincemail J., Dekoster G. (2000) SMA circuits reduce platelet consumption and platelet factor release during cardiac surgery. Ann. Thorac. Surg 70:2075-2081.
Hansbro S.D., Sharpe D.A.C., Catchpole R. (1999) Haemolysis during cardiopulmonary bypass: An in vivo comparison of standard roller pumps, nonocclusive roller pumps and centrifugal pumps. Perfusion 14:3-10.
Asimakopoulos G. (1999) Mechanisms of the systemic inflammatory response. Perfusion 14:269-277.
Tabuchi N., de Haan J., Boonstra P.W., van Oeveren W. (1993) Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg 106:828-833.
Fuller J.A., Buxton B.F., Picken J., Harris R.A., Davies M.J. (1991) Haematological effects of reinfused mediastinal blood after cardiac surgery. Med. J. Aust 154:737-740.
Griffith L.D., Billman G.F., Daily P.O., Lane T.A. (1989) Apparent coagulopathy caused by infusion of shed blood and its prevention by washing of the infusate. Ann. Thorac. Surg 47:400-406.
Larson F.D., Bowers M., Schechner W. (1996) Neutrophil activation during cardiopulmonary bypass in pediatric and adult patients. Perfusion 11:21-27.
Lahat N., Zlotnick A.Y., Shtiller R., Bar I., Merin G. (1992) Serum levels of IL-1, IL-6 and tumour necrosis factors in patients undergoing artery bypass grafts or cholecystectomy. Clin. Exp. Immunol 89:255-260.
Faymonville M.E., Pincemail J., Duchateau J. (1991) Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. J. Thorac. Cardiovasc. Surg 102:309-317.
Giordano G.F., Goldman D.S., Mammana R.B. (1988) Intra-operative autotransfusion in cardiac operations. Effect of intraoperative and postoperative transfusion requirements. J. Thorac. Cardiovasc. Surg 96:632-641.
Fransen E., Maessen J., Dentener M., Senden N., Buurman W. (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery. Chest 116:1233-1239.
Dzik W.H., Fleisher A.G., Ciavarella D., Karlson K.J., Reed G.E., Berger R.L. (1993) Safety and efficacy of autologous blood donation before elective aortic valve operation. Ann. Thorac. Surg 56:95-96.
Berty A., Doutremoepuich C., Baudet E. (1986) Transfusional quality of residual blood from heart-lung machine after extracorporeal circulation. Perfusion 1:179-185.
Merville C., Charlet P., Zerr C., Bricard H. (1991) Efficacité respective du Cell Saver et de la récupération du circuit de CEC ultrafiltré en chirurgie cardiaque. Ann. Fr. Anesth. Réanim 10:548-553.
Ranucci M., Soro G., Frigiola A. (1997) Normothermic perfusion and lung function after cardiopulmonary bypass: Effects in pulmonary risk patients. Perfusion 12:309-315.
de Haan J., Boonstra P.W., Monninck S.H., Ebels T., van Oeveren W. (1995) Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis. Ann. Thorac. Surg 59:901-907.
van Oeveren W., Harder M.P., Roozendaal K.J., Eysman L., Wildevuur C.R. (1990) Aprotinin protect platelets against the initial effects of cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg 99:788-797.
Sieunarine K., Lawrence-Brown M.M., Brennan D., Langston S., Goodman M.A., Hellings M. (1992) The quality of blood used for transfusion. J. Cardiovasc. Surg 33:98-105.
Tawes R.L. Jr., Duvall T.B. (1996) Is the 'salvaged-cell syndrome' myth or reality?. Am. J. Surg 172:172-174.
Reents W., Babin-Ebell J., Misoph M.R., Schwarzkopf A., Elert O. (1999) Influence of different autotransfusion devices on the quality of salvaged blood. Ann. Thorac. Surg 68:58-62.
Stokke T., Burchardi H., Kostering H., Kathner T., Rohlf G. (1986) Continuous intravenous infusion of elastase in normal and agranulocytic minipigs - Effects on the lung and the blood coagulation system. Resuscitation 14:61-79.
Santrach P.J., Willis E.A., Mathison B.A., Oeltjen A.M. (1998) Performance characteristics of a modified centrifuge bowl for blood salvage. Transfusion , Mayo Clinic Study; 38(SUPPL. 294).
Bull B.S., Bull M.H. (1990) The salvaged blood syndrome: A sequel to mechanochemical activation of platelets and leukocytes?. Bloods Cells 16:5-23.
Janssen N.J.G., van Oeveren W., van Vlioet M., Wildevuur C.R.H. (1991) The role of different types of corticosteroids in the inflammatory mediators in cardiopulmonary bypass. Eur. J. Cardiothorac. Surg 5:211-217.
Haeffner-Cavaillon N., Roussellier N., Ponzio O. (1989) Induction of IL-1 production in patients undergoing cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg 98:1100-1106.
Defraigne J.O., Pincemail J., Larbuisson R., Blaffart F., Limet R. (2000) Cytokine release and neutrophil activation are not prevented by heparin-coated circuits and aprotinin administration. Ann. Thorac. Surg 69:1084-1091.
Walpoth B.H., Eggensperger N., Walpoth-Aslan B.N. (1997) Qualitative assessment of blood washing with continuous autologous transfusion system (CATS). Int. J. Artif. Organs 20:234-239.
Dewitz T.S., McIntire L.V., Martin R.R., Sylees H.D. (1979) Enzyme release and morphological changes induced by mechanical trauma blood cells. Blood Cells 5:499-512.