AN EVALUATION OF CHANGES IN COMPOSITION AND CONTAMINATION OF SALVAGEDBLOOD FROM THE CARDIOPULMONARY BYPASS CIRCUIT OF PEDIATRIC-PATIENTS

Objective: To review changes that occur during an 18-hour period in co mposition and bacterial contamination of blood salvaged from the cardi opulmonary bypass (CPB) circuit of pediatric patients. Design: Prospec tive, blinded study. Setting: Pediatric tertiary multidisciplinary int ensive care unit. Patients: One hundred and one children who underwent CPB. Outcome Measures: The degree of bacterial contamination and bioc hemical and hematologic alterations of blood salvaged from the CPB and any increased blood loss associated with reinfusion of this blood. In tervention: The salvaged blood from the CPB circuit was collected into 1 L blood transfer packs after CPB. This blood was then stored at roo m temperature for 18 hours. Sampling occurred immediately after CPB an d at 6 and 18 hours for biochemic and hematologic assay and for the de tection of bacterial organisms. The amount of chest drainage loss was assessed in the first 18 hours after bypass. The type and amount of in travenous fluid infused also was recorded. Results: Bacterial contamin ation occurred in three samples (two at 6 hours and in one of the prec eding at 18 hours) of the 101 units of salvaged blood. All three posit ive cultures grew a coagulase-negative staphylococcus. Sodium and pota ssium remained within normal physiologic values. The glucose values de clined from 15.8 to 13.4 mmol/L, and the hemoglobin values increased f rom 0.4 to 0.5 gm/dl. The reinfusion of the salvaged blood (and any ot her blood or blood products) to 31 of the 101 patients averaged 14.2 m l/kg/24 hr, with a mean chest drainage loss of 4.9 ml/kg/24 hr. The re maining 70 patients received 12.5 ml/kg/hr of either plasma expanders or blood, with a mean chest drainage loss of 6.0 ml/kg/24 hr. Conclusi ons: The results of this study demonstrate minimal chemical deteriorat ion and limited microbiologic contamination in blood that was salvaged from the CPB circuit and stored at room temperature for an 18-hour pe riod. No increase in postoperative bleeding was noted from the use of this blood. These results suggest it may be safe to reinfuse salvaged blood after CPB in pediatric patients for up to 18 hours; however, a p rospective clinical trial is needed to validate these findings.