番茄社区

SAN DIEGO -- While thoracic surgeons have traditionally favored allogenic transfusions in the operating room, blood-conserving autologous transfusions in cardiac procedures were linked to shorter hospital stays and other patient benefits, a study showed.

Patients treated at a single center after it switched to a protocol for autologous blood collection at the beginning of the procedure and reinfusion at the end fared better on several measures than those treated before implementation:

• Blood transfusion in the post-operative period (40% vs 70%, P<0.001)
• Total transfusions of packed red blood cells (0.79 vs 1.76 units, P<0.001)
• Chest tube output (1,207 vs 1,295 ml, P=0.038)
• Length of stay (6.8 vs 7.8 days, P<0.001)

"This is an evolutionary development. It seems like it's something simple, but the effects far outweigh the small upfront investment in changes in thought," said study lead author Eric Zimmermann, MD, a post-doctoral researcher at Oregon Health and Science University in Seattle and general surgery resident at NewYork-Presbyterian Queens Hospital in New York City, in an interview.

The single-center findings, from a retrospective analysis, were presented here at the annual meeting of the Society of Thoracic Surgeons.

In 2013, cardiac surgeons at NewYork-Presbyterian Queens Hospital began embracing an aggressive intraoperative autologous donation protocol in cardiac procedures.

According to Zimmermann, nearly all non-emergency cardiac surgery patients at the hospital were given transfusions of 500 ccs to 1 liter of their own blood, depending on their weight and hematocrit level. The blood is drawn prior to the procedure and then hung in a cooler.

"It sounds ridiculously simple," Zimmermann said. "You take it off, you let it sit there, and then you give it back. It doesn't leave the operating room."

For the study, researchers compared 689 patients who were treated before the implementation of the 2013 protocol (from 2009-2013) and 420 patients treated afterward.

The only extra cost of using autologous blood is the very small expense of blood storage bags and a refrigerator where they're stored during the procedure, Zimmermann said. Cost savings come from reduced use of allogenic blood and shorter hospital stays, he said.

Autologous blood removed prior to surgery isn't subject to unintended effects from heparin, Zimmermann noted. It also avoids trauma of the cardiopulmonary bypass machine, which "activates platelets, promotes inflammation, and causes damage to red blood cells, in some cases causing direct red cell destruction."

"We believe one of the reasons this blood is better is because it doesn't develop inflammatory factors," Zimmerman added.

Future research should prospectively analyze the use of autologous blood, he said.

Comment