Poster (Scientific congresses and symposiums)
Postoperative bleeding and autotransfusion
ERPICUM, Marie; BLAFFART, Francine; DEFRAIGNE, Jean et al.
201213th symposium on perfusion "Questioning the obvious in CPB practice"
 

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Keywords :
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 center :
Service de chirurgie cardiovasculaire et thoracique
Disciplines :
Surgery
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
Language :
English
Title :
Postoperative bleeding and autotransfusion
Alternative titles :
[en] Saignement postoperatoire et autotransfusion
Publication date :
29 September 2012
Event name :
13th symposium on perfusion "Questioning the obvious in CPB practice"
Event organizer :
The Belgian Society of Extracorporeal Technology - BelSECT
Event place :
Bruxelles, Belgium
Event date :
29 septembre 2012
Audience :
International
Name of the research project :
L'épargne sanguine à travers l'itinéraire clinique du patient opéré cardiaque
Available on ORBi :
since 05 November 2012

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