BMJ 2002;324:1299 ( 1 June )

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Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial

Neil McGill, visiting instructor, a Denise O'Shaughnessy, consultant haematologist, b Ruth Pickering, lecturer in medical statistics, c Mike Herbertson, consultant cardiac anaesthetist, d Ravi Gill, consultant cardiac anaesthetist. d

a C S Mott Children's Hospital, Section of Pediatric Anesthesiology, Room F3900, Box 0211, Ann Arbor, MI 48109-0211, USA, b Department of Haematology, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, c Medical Statistics Group, Southampton University Hospitals NHS Trust, d Shackleton Department of Anaesthesia, Southampton University Hospitals NHS Trust

Correspondence to: R Gill ravi.gill{at}suht.swest.nhs.uk

Objective: To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery.
Design: Randomised controlled trial.
Setting: Regional cardiac centre in a teaching hospital in Southampton.
Participants: 263 adults aged 18-80 years undergoing elective coronary artery bypass surgery entered the study, of whom 252 completed the trial. All patients received routine perioperative care. Patients were allocated to one of three treatment groups: intraoperative cell salvage, intraoperative cell salvage with acute perioperative normovolaemic haemodilution, or no mechanical blood conservation. There were 84 patients in each group.
Main outcome measures: Numbers of patients who received allogeneic blood or coagulation products, and the mean number of units of blood transfused per patient.
Results: Of the patients in the intraoperative cell salvage group, 26 were given a transfusion of allogeneic blood, compared with 43 in the control group (odds ratio 0.43 (95% confidence interval 0.23 to 0.80)). The mean number of units of allogeneic blood transfused per patient in the intraoperative cell salvage group was 0.68 units (SD=1.55), compared with 1.07 (1.56) units in the control group. 32 of the patients in the intraoperative cell salvage group were given any blood product, compared with 47 in the control group (odds ratio 0.47 (0.25 to 0.89); P=0.019). Combining acute perioperative normovolaemic haemodilution with intraoperative cell salvage conferred no additional benefits.
Conclusions: An intraoperative cell salvage device should be used in elective coronary artery bypass grafting. Pharmacological strategies may achieve further reductions in blood transfusions. Yet further reductions in blood transfusions could be achieved if the lower safe limit of haemoglobin concentration in patients undergoing cardiac surgery were known.

What is already known on this topic
Patients undergoing elective coronary artery bypass surgery often need a blood transfusion

Recent meta-analyses have shown that the mechanical blood conservation techniques of intraoperative cell salvage and acute perioperative normovolaemic haemodilution may reduce the need for transfusion, but flawed methods in trials mean that clear evidence in cardiac surgery is lacking

What this study adds
Intraoperative cell salvage significantly reduces the number of patients needing an allogeneic blood transfusion

Combining acute perioperative normovolaemic haemodilution with intraoperative cell salvage does not confer any additional benefit




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