evaluation of cardiopat r autotransfusion system in elective cardiac surgery
DESCRIPTION
Evaluation of CardioPAT R autotransfusion system in elective cardiac surgery. De Decker K. 1 ; Bogaert T 2* ; Gooris T 2* ; Stockman B 2 ; 1: Dept of Anesthesiology and Intensive Care Medicine, 2: Department of cardiovascular surgery ( *Perfusionist) O.-L.-Vrouw Hospital Aalst, Belgium. - PowerPoint PPT PresentationTRANSCRIPT
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.
De Decker K.1; Bogaert T2*; Gooris T2*; Stockman B2;
1: Dept of Anesthesiology and Intensive Care Medicine, 2: Department of cardiovascular surgery ( *Perfusionist)
O.-L.-Vrouw Hospital Aalst, Belgium
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.
• No conflict of interest
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• RBC transfusion was an independent risk
factor for clinical complications after cardiac surgery (1)
• In order to reduce blood transfusion and consequently its immunological complications, several strategies have been investigated.
• One of them is the use of cell saving devices and autologous transfusion.
• With this intention the cardioPATR system (Haemonetics, Braintree, MA) was designed, which is – more flexible than classical cell saving devices – and thereby also very convenient for prolonged use in the
postoperative period. 1. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. JAMA 2010; 304(14): 1559-67.
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• Salvages red blood cells lost during
and after cardiovascular surgery• Concentrates and washes red cells to
a hematocrit of 70% to 80%– RBC recovery between 76% and 92%– High quality RBC product
• Albumin removal : 97.1% - 99.9%• Free hemoglobin removal 93.4% -
99.5%• Heparin removal : 96.8% - 100%
• Small, portable and easy to use
http://www.haemonetics.com/en/Products/Devices/Surgical%20-%20Diagnostic%20Devices/cardioPAT.aspx
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• During the implementation phase of the device
the following data were observed – perioperative blood loss– autologous transfusion rates – and especially the use of allogenic blood products
• 523 cardiac surgery cases (M/F = 326/197 ; mean age 70 yr) – Used most frequently in CABG, mitral valve plasty
and double (or triple) valve operations. – In 50 patients ( 9,5 %) a classical cell saver was used
intraoperatively– In 18 patients cardioPAT was started postoperatively.
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.
total avg. revision redo0
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totalintraoppostop
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.
• The transfusion trigger for was 9 g/dl of hemoglobin.
• 79 patients received only 1 PC
• Transfusion rates were higher (counting for nearly 29 % of all products) in – in redo cases (88 % of
pats.; avg. 3, 7 U) – revised patients (100
% of pats; avg. 5 U)
PC FFP PLATELETS0
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totalintraoppostop
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• Postoperative period only : average of
– 0, 61 PC/patient in 20 % (n = 102) of patients – 0,35 FFP– 0,14 pools of platelets
• During the observation period a reduction of overall transfusion rates was seen – Packed cells : from 2.17 ( n = 100) to 1.63
PC/patient (n=523) – A similar decline was seen for FFP ( 0,36 -> 0,296
U )and platelets (0,96 to 0,71 U)• No device-related serious adverse events were
noticed during the observation period.
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• Around 30 well designed trials ( n = 2282) studied the
use of cell saving and a meta-analysis showed that the exposure to any allogeneic blood product was decreased(2) – No difference in other outcome parameters – Almost all studies however deal with intraoperative use of cell saving, and
in a majority of them only cardiotomy suction blood is retransfused
• Only 1 RCT with CardioPATR in 512 patients (3) : – Comparing intra-operative classical cell saving with intra- and postoperative
use of the cardioPAT system – Autologous transfusion :
• 370 + 250 ml intraoperatively• 350 + 370 ml postoperatively
– Reduction of allogeneic transfusion per patient • from 2,11 + 0,9 to 1.2 + 0,8 units • 37 % vs. 57,13 % of patients • Respectively 11,7 % and 18,8 % required 1 unit only
2. The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Wang F, Bainbridge D, Martin J, Cheng D. Anesth Analg 2009;109:320-30.3. Weltert L. et al. Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra- and postoperative blood salvage strategy: results of a randomized comparison. Transfusion 2013; 53:790-7.
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• Over 70 % patients received PC in historic control
sample vs. 54,4 % in cardioPAT group – Excluding the patients receiving only 1 unit ( with trigger
9/dl) would further reduce the group of patients needing allogeneic PCs to 39 %.
– The decrease in PC transfusion during the observation period was biased by a changing transfusion trigger .
• Comparisons with literature data are difficult for several reasons (redo cases excluded , only postoperative used evaluated,..).– The average transfusion amount of 0,61 units of PC/patient
however is comparable with literature data
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Evaluation of CardioPATR
autotransfusion system in elective cardiac surgery.• Autologous transfusion in elective cardiac
surgery can be done safely with the CardioPATR auto transfusion device.
• Due to the transfusion of autologous blood, allogeneic transfusion can be reduced especially in the postoperative period.
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AcknowledgementsBogaert Thierry