ORBi: ERPICUM Marie - Postoperative bleeding and autotransfusion

Reference : Postoperative bleeding and autotransfusion


	Document type :	Scientific congresses and symposiums : Poster
	Discipline(s) :	Human health sciences : Surgery
	To cite this reference:	http://hdl.handle.net/2268/133425

Title :	Postoperative bleeding and autotransfusion
Language :	English
Alternative title :	[en] Saignement postoperatoire et autotransfusion
Author, co-author :	ERPICUM, Marie [Centre Hospitalier Universitaire de Liège - CHU > > Bloc opératoire chirurgie cardio-vasculaire >]
	BLAFFART, Francine [Centre Hospitalier Universitaire de Liège - CHU > > Bloc opératoire chirurgie cardio-vasculaire >]
	DEFRAIGNE, Jean [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie cardio-vasculaire >]
	LARBUISSON, Robert [Centre Hospitalier Universitaire de Liège - CHU > > Anesthésie et réanimation >]
Publication date :	29-Sep-2012
On invitation :	No
Audience :	International
Event name :	13th symposium on perfusion "Questioning the obvious in CPB practice"
Event date :	29 septembre 2012
Event organizer :	The Belgian Society of Extracorporeal Technology - BelSECT
Event place (city) :	Bruxelles
Event country :	Belgique
Keywords :	[en] Autotransfusion ; Cardiac surgery ; Postoperative bleeding
Abstract :	[en] Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could potentially be managed with a cell salvage device during the first six postoperative hours. This practice is generally performed only in case of a surgical re-exploration for massive bleeding and may contribute to decreased allogeneic transfusion. But in case of postoperative coagulopathy requiring medical treatment, re-exploration is usually postponed and consequently, collected blood is discarded. Therefore, chest drainage systems combined with a cell salvage option could optimize the management of blood losses and transfusions in the postoperative period, regardless of any surgical re-exploration. The aim of this study is to assess the effectiveness of such a system during the postoperative period of cardiac surgery, in patient at high risk of bleeding. Method : During a 6 months period, the CardioPAT® (Haemonetics) device was used in all cardiac surgery patients at high risk of postoperative bleeding. The following data were prospectively collected: hemoglobin level, bleeding volume, volume of autologous washed red blood cell transfused by the CardioPAT® (WRBC), volume of allogeneic red blood cell (RBC), fresh frozen plasma (FFP) or platelets (PT) transfused and surgical re-exploration. Results : The CardioPAT® was used in 16 patients during the target period. Mean postoperative bleeding volume was 338±337mL after 1 hour and 820±727mL after 6 hours. The cell salvage option was used in 9 (56%) cases and mean WRBC transfused volume was 153±212mL. One patient required surgical re-exploration. All patients transfused by WRBC received previously an allogeneic transfusion (RBC, FFP and/or PT). The hemoglobin level of blood collected in the CardioPAT® device impacted on the delay and the blood volume required for WRBC availability; lower was the hemoglobin level, larger was the volume of blood required to obtain a concentrate of WRBC. Consequently, patients with a very low hemoglobin level were anyway transfused with RBC. Conclusion : The CardioPAT® device can reduce allogeneic blood transfusion after cardiac surgery in patients at high risk of bleeding. It gives time to treat coagulopathy, leading to a decrease of surgical re-exploration. However, a device with a larger reservoir and with a flexible processing speed would be more accurate in case of major haemorrhage. Systematic utilisation of this device at the time of FFP and/or PT transfusion is a safe but expensive strategy. It seems more accurate to use this device in a permissive bleeding strategy, waiting for the spontaneous coagulation recovery of the patient, in the first postoperative hours.
Research units :	Service de chirurgie cardiovasculaire et thoracique
Name of the research project :	L'épargne sanguine à travers l'itinéraire clinique du patient opéré cardiaque
Target :	Researchers ; Professionals ; Students
Permalink :	http://hdl.handle.net/2268/133425

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