Mark Alm, Margarita Otalora-Esteban, Natasha Bush, Amanda Dranfield, Keyvan Karkouti, Brian Beairsto
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Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.</p><p><strong>Results: </strong>A total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL<sup>-1</sup> processed red cells. Median RBC recovery rates also showed significant differences between processing sets, ranging from 8 [8-10] mL RBC·min<sup>-1</sup> to 24 [22-25] mL RBC·min<sup>-1</sup>.</p><p><strong>Conclusion: </strong>Wash quality and processing speed differed between autotransfusion devices and processing sets. These findings may have clinical implications when large volumes of shed blood are processed and reinfused.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"417-425"},"PeriodicalIF":3.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Quality comparison of autotransfusion devices in cardiac surgery: a prospective observational cohort study.\",\"authors\":\"Mark Alm, Margarita Otalora-Esteban, Natasha Bush, Amanda Dranfield, Keyvan Karkouti, Brian Beairsto\",\"doi\":\"10.1007/s12630-024-02893-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We sought to conduct a quality improvement initiative to compare the wash quality and speed of autologous red blood cell (RBC) processing of four autotransfusion devices during cardiac surgery.</p><p><strong>Methods: </strong>Using a prospective observational cohort study approach, we prospectively evaluated four commercially available autologous cell savage devices (autoLog IQ™, Medtronic plc, Minneapolis, MN, USA [135 mL]; Xtra™, LivaNova, plc, Houston, TX, USA [125 mL, 225 mL]; Cell Saver® Elite®+, Haemonetics Corp., Boston, MA, USA [125 mL, 225 mL]; and CATSmart®, Fresenius Kabi AG, Bad Homburg vor der Höhe, Germany) in adult patients undergoing cardiac surgery. Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.</p><p><strong>Results: </strong>A total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL<sup>-1</sup> processed red cells. 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引用次数: 0
摘要
目的：我们试图进行一项质量改进倡议，以比较心脏手术中四种自体输血装置的冲洗质量和自体红细胞（RBC）处理速度。方法：采用前瞻性观察队列研究方法，前瞻性评估了四种市售的自体细胞savage装置(autoLog IQ™，Medtronic plc, Minneapolis， MN, USA [135 mL]；Xtra™，LivaNova, plc，休斯顿，德克萨斯州，美国[125 mL， 225 mL]；Cell Saver®Elite®+，Haemonetics公司，波士顿，马萨诸塞州，美国[125 mL， 225 mL]；和CATSmart®，Fresenius Kabi AG, Bad Homburg vor der Höhe，德国)，用于接受心脏手术的成人患者。设备设置由制造商推荐的最佳洗涤质量决定。我们收集每个设备的预处理和后处理样品、体积和处理时间，以计算肝素、钾、血浆游离血红蛋白（PfHb）、白细胞（wbc）、血小板的去除率、肝素和钾的再输注浓度以及红细胞（RBC）的回收率。结果：共130例患者接受了自体细胞修复术，其中15例因资料不完整而被排除。所有装置从收集的血中去除bbb99%的肝素，> 95%的钾，> 94%的血小板，> 85%的PfHb。处理组的比较显示，白细胞去除率的中位数[四分位数范围]（26[19-33]%至59[42-68]%）和肝素再输注浓度的中位数（0.09[0.08-0.11]至0.63 [0.55-0.70]U·mL-1处理红细胞）存在显著差异。中位RBC回收率在处理组之间也有显著差异，从8 [8-10]mL RBC·min-1到24 [22-25]mL RBC·min-1。结论：自体输液装置与处理装置的清洗质量和处理速度存在差异。这些发现可能对处理和再输注大量流出的血液具有临床意义。
Quality comparison of autotransfusion devices in cardiac surgery: a prospective observational cohort study.
Purpose: We sought to conduct a quality improvement initiative to compare the wash quality and speed of autologous red blood cell (RBC) processing of four autotransfusion devices during cardiac surgery.
Methods: Using a prospective observational cohort study approach, we prospectively evaluated four commercially available autologous cell savage devices (autoLog IQ™, Medtronic plc, Minneapolis, MN, USA [135 mL]; Xtra™, LivaNova, plc, Houston, TX, USA [125 mL, 225 mL]; Cell Saver® Elite®+, Haemonetics Corp., Boston, MA, USA [125 mL, 225 mL]; and CATSmart®, Fresenius Kabi AG, Bad Homburg vor der Höhe, Germany) in adult patients undergoing cardiac surgery. Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.
Results: A total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL-1 processed red cells. Median RBC recovery rates also showed significant differences between processing sets, ranging from 8 [8-10] mL RBC·min-1 to 24 [22-25] mL RBC·min-1.
Conclusion: Wash quality and processing speed differed between autotransfusion devices and processing sets. These findings may have clinical implications when large volumes of shed blood are processed and reinfused.
期刊介绍：
The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’
Society and is published by Springer Science + Business Media, LLM (New York). From the
first year of publication in 1954, the international exposure of the Journal has broadened
considerably, with articles now received from over 50 countries. The Journal is published
monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article
types consist of invited editorials, reports of original investigations (clinical and basic sciences
articles), case reports/case series, review articles, systematic reviews, accredited continuing
professional development (CPD) modules, and Letters to the Editor. The editorial content,
according to the mission statement, spans the fields of anesthesia, acute and chronic pain,
perioperative medicine and critical care. In addition, the Journal publishes practice guidelines
and standards articles relevant to clinicians. Articles are published either in English or in French,
according to the language of submission.
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