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CARDIOVASCULAR ANESTHESIOLOGY

The Efficacy of an Intraoperative Cell Saver During Cardiac Surgery: A Meta-Analysis of Randomized Trials

Guyan Wang, MD, PhD^*, Daniel Bainbridge, MD, FRCPC^*, Janet Martin, PharmD, MSc (HTA&M)^*, and Davy Cheng, MD, MSc, FRCPC, FCAHS^*

From the *Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada; Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology and Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR), and Department of Pharmacy, Physiology, and Pharmacology, High Impact Technology Evaluation Centre, Pharmacy, Physiology and Pharmacology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Daniel T. Bainbridge, MD, FRCPC, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Rd., Room C3-106, London, Ontario, Canada N6A 5A5. Address e-mail to daniel.bainbridge{at}lhsc.on.ca.

Abstract

BACKGROUND: Cell salvage may be used during cardiac surgery to avoid allogeneic blood transfusion. It has also been claimed to improve patient outcomes by removing debris from shed blood, which may increase the risk of stroke or neurocognitive dysfunction. In this study, we sought to determine the overall safety and efficacy of cell salvage in cardiac surgery by performing a systematic review and meta-analysis of published randomized controlled trials.

METHODS: A comprehensive search was undertaken to identify all randomized trials of cell saver use during cardiac surgery. MEDLINE, Cochrane Library, EMBASE, and abstract databases were searched up to November 2008. All randomized trials comparing cell saver use and no cell saver use in cardiac surgery and reporting at least one predefined clinical outcome were included. The random effects model was used to calculate the odds ratios (OR, 95% confidence intervals [CI]) and the weighted mean differences (WMD, 95% CI) for dichotomous and continuous variables, respectively.

RESULTS: Thirty-one randomized trials involving 2282 patients were included in the meta-analysis. During cardiac surgery, the use of an intraoperative cell saver reduced the rate of exposure to any allogeneic blood product (OR 0.63, 95% CI: 0.43-0.94, P = 0.02) and red blood cells (OR 0.60, 95% CI: 0.39-0.92, P = 0.02) and decreased the mean volume of total allogeneic blood products transfused per patient (WMD –256 mL, 95% CI: –416 to –95 mL, P = 0.002). There was no difference in hospital mortality (OR 0.65, 95% CI: 0.25-1.68, P = 0.37), postoperative stroke or transient ischemia attack (OR 0.59, 95% CI: 0.20-1.76, P = 0.34), atrial fibrillation (OR 0.92, 95% CI: 0.69-1.23, P = 0.56), renal dysfunction (OR 0.86, 95% CI: 0.41-1.80, P = 0.70), infection (OR 1.25, 95% CI: 0.75-2.10, P = 0.39), patients requiring fresh frozen plasma (OR 1.16, 95% CI: 0.82-1.66, P = 0.40), and patients requiring platelet transfusions (OR 0.90, 95% CI: 0.63-1.28, P = 0.55) between cell saver and noncell saver groups.

CONCLUSIONS: Current evidence suggests that the use of a cell saver reduces exposure to allogeneic blood products or red blood cell transfusion for patients undergoing cardiac surgery. Subanalyses suggest that a cell saver may be beneficial only when it is used for shed blood and/or residual blood or during the entire operative period. Processing cardiotomy suction blood with a cell saver only during cardiopulmonary bypass has no significant effect on blood conservation and increases fresh frozen plasma transfusion.