Efficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte removal from shed mediastinal blood: a randomized controlled trial.
LAGNY, Marc-Gilbert ; GOTHOT, André ; HANS, Grégory et al
in Perfusion (2016)
Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles ... [more ▼]
Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles and activated leucocytes with shed mediastinal blood (SMB) can aggravate cardiopulmonary bypass-associated inflammation and increase the embolic load. This study evaluated the fat and leucocyte removal capacity of the RemoweLL cardiotomy reservoir. Methods Forty-five patients undergoing elective on-pump cardiac surgery were randomly allocated to filtration of SMB using the RemoweLL or the Admiral cardiotomy reservoir. The primary outcome was the drop in leucocytes and lipid particles obtained with the two filters. The effect of the filters on other blood cells and inflammatory mediators such as myeloperoxidase (MPO) was also assessed. Results The RemoweLL cardiotomy filter removed 16.5 % of the leucocytes (P < 0.001) while no significant removal of leucocytes was observed with the Admiral (P = 0.48). The percentage reductions in lipid particles were similar in the two groups (26% vs 23 %, P = 0.2). Both filters similarly affected the level of MPO (P = 0.71). Discussion The RemoweLL filter more effectively removed leucocytes from SMB than the Admiral. It offered no advantage in term of lipid particle clearance. [less ▲]Detailed reference viewed: 29 (11 ULg)
Prediction of the post-dilution hematocrit during cardiopulmonary bypass. Are new formulas needed?
ERPICUM, Marie ; Dardenne, Nadia ; HANS, Grégory et al
in Perfusion (2016)
Objectives: Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead ... [more ▼]
Objectives: Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead to large errors. We aimed to improve the accuracy of these formulas by a better estimation of the dilution volume and the patient circulatory blood volume. Methods: We compared the estimation accuracy of two formulas, using fixed (formula A) versus estimated (formula D) dilution volume and patient circulatory blood volume for 100 cardiac interventions. The difference between predicted and measured HctT1 was considered as “good” if less than 0.5%, “moderate” between 0.5 and 2% and “poor” if higher than 2%. The influence of the body mass index (BMI) on patient blood volume estimation was explored by categorized groups’ comparison. Results: The mean difference between predicted and measured HctT1 differed significantly between formulas A and D. Formula A didn’t differ from HctT1 (p=0.19, IC95% [-0.89-0.18]), but a significant and higher underestimation was observed in the BMI⩽25 group compared to the other BMI groups (p<0.001). Formula D overestimated HctT1 (p<0.001, IC95% [1.01-1.93]) without a difference between the BMI groups. No difference was observed in their overall proportions of good (11 vs 10%), moderate (44 vs 46%) and poor predictions (47 vs 44%) (p=0.117). Conclusions: Formulas used for post-dilution hematocrit prediction lead to major estimation errors and a risk of inadequate transfusion practices. Estimations performed by experienced clinicians could not minimize these biases in all clinical cases as significant errors remain, with potential clinical impact. No estimation formula should be used as a hard tool for transfusing patients, but rather as a guide to predicting the probability of transfusion requirement. [less ▲]Detailed reference viewed: 18 (7 ULg)
Definition of moderate ischemic mitral regurgitation: it's time to speak the same language.
; ; LANCELLOTTI, Patrizio
in Perfusion (2013), 28(2), 173-5Detailed reference viewed: 43 (2 ULg)
Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit
AMAND, Théophile ; Pincemail, Joël ; Blaffart, Francine et al
in Perfusion (2002), 17(2), 117-123
Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous ... [more ▼]
Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another. [less ▲]Detailed reference viewed: 9 (1 ULg)