Influence of different autotransfusion devices on the quality of salvaged blood

Background. Cardiopulmonary bypass causes a systemic inflammatory response and impaired hemostasis. We investigated whether intraoperative blood salvage with the cardiotomy suction contributes to these alterations. Furthermore, an alternative autotransfusion device (Haemonetics cell-saving device) was examined. Methods. In 10 patients, interleukin-6, interleukin-8, tumor necrosis factor-alpha, thrombin-antithrombin complex, plasmin-antiplasmin complex, free hemoglobin, and the percentage of CD62(+) thrombocytes were determined in the systemic circulation during cardiopulmonary bypass, in the cardiotomy suction tube, and in the blood from the cell-saving device. Additionally, bacterial contamination was examined. Results. Median levels of interleukin-6 (52 versus 10 mu g/L; p = 0.005), interleukin-8 (26 versus 20 mu g/L; p = 0.017), tumor necrosis factor-alpha (24 versus 1 mu g/L; p = 0.005), thrombin-antithrombin complex (113 versus 43 mu g/L; p = 0.005), plasmin-antiplasmin complex (566 versus 489 mu g/L; p = 0.022), and free hemoglobin (61 versus 30 mg/dL; p = 0.005) were higher in the cardiotomy suction tube compared with the systemic circulation. After processing the blood from the cell-saving device, interleukin-8, thrombin-antithrombin complex, and free hemoglobin remained above reference range, and in 90% of the cases bacterial contamination was observed. Conclusions. Cardiotomy suction additionally contributes to the release of proinflammatory cytokines, activation of coagulation, and hemolysis. Because blood salvage with a Haemonetics cell-saving device led to normalization of some, but not all, parameters and bacterial contamination was common, the alternative use seems at least questionable. (C) 1999 by The Society of Thoracic Surgeons.