The Safety and Therapeutic Effectiveness of Nonwashed Mediastinal Shed Blood Reinfused Into Patients Following Open Heart Surgery

This prospective study was designed to determine if use of nonwashed shed mediastinal blood could exacerbate platelet and related hematologic dysfunctions following cardiopulmonary bypass (CPB) when compared to the alternative use of autologous and homologous liquid preserved blood for volume suppor...

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Bibliographic Details
Main Authors: Axford, Trevor C, Dearani, John A, Ragno, Gina, MacGregor, Hollace, Patel, Manisha A
Format: Report
Language:English
Subjects:
BLOOD CHEMISTRY
BLOOD CIRCULATION
BLOOD PLASMA
BLOOD PLATELETS
BLOOD PROTEINS
BLOOD TRANSFUSION
BLOOD VOLUME
CARDIOPULMONARY BYPASS
HEART SURGERY
HEMORRHAGE
MEDIASTINAL SHED BLOOD
Medicine and Medical Research
PLATELET DYSFUNCTIONS
SURGERY
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Summary:This prospective study was designed to determine if use of nonwashed shed mediastinal blood could exacerbate platelet and related hematologic dysfunctions following cardiopulmonary bypass (CPB) when compared to the alternative use of autologous and homologous liquid preserved blood for volume support. Thirty-two patients undergoing CPB for open heart surgery were randomized to receive either nonwashed shed mediastinal (NSM) blood (Group 1, n = 16) or liquid preserved packed red blood cells (Group 2, n = 16) for transfusion (TXN) therapy of postoperative bleeding. Patient blood samples and bleeding times were obtained preoperatively, postCPB-preTXN, 2 and 24 hours postTXN, and on postoperative days 2, 3, and 7. Group 1 patients received an average of 710 +/- 90 ml (range 300-1700 ml) of NSM blood containing significantly greater (p < 0.0001) amounts of fibrin degradation products and D-dimer protein. Of the hematologic, microaggregate, and plasma protein measurements performed, only Protein C was significantly greater (p < 0.05, 1 vs. 2) after transfusion. Patient bleeding times were not significantly different between the groups at all time points. Total postoperative blood loss was not different between groups. There was a trend toward less need for homologous transfusion in Group 1 (p < 0.1). This study documents the safety, ease, and cost-saving of using nonwashed shed mediastinal blood as primary blood volume support following open heart surgery.