Influence of different autotransfusion devices on the quality of salvaged blood

Background. Cardiopulmonary bypass causes a systemic inflammatory response and impaired hemostasis. We investigated whether intraoperative blood salva ge with the cardiotomy suction contributes to these alterations. Furthermor e, an alternative autotransfusion device (Haemonetics cell-saving device) w as examined. Methods. In 10 patients, interleukin-6, interleukin-8, tumor necrosis facto r-alpha, thrombin-antithrombin complex, plasmin-antiplasmin complex, free h emoglobin, and the percentage of CD62(+) thrombocytes were determined in th e systemic circulation during cardiopulmonary bypass, in the cardiotomy suc tion tube, and in the blood from the cell-saving device. Additionally, bact erial contamination was examined. Results. Median levels of interleukin-6 (52 versus 10 mu g/L; p = 0.005), i nterleukin-8 (26 versus 20 mu g/L; p = 0.017), tumor necrosis factor-alpha (24 versus 1 mu g/L; p = 0.005), thrombin-antithrombin complex (113 versus 43 mu g/L; p = 0.005), plasmin-antiplasmin complex (566 versus 489 mu g/L; p = 0.022), and free hemoglobin (61 versus 30 mg/dL; p = 0.005) were higher in the cardiotomy suction tube compared with the systemic circulation. Aft er processing the blood from the cell-saving device, interleukin-8, thrombi n-antithrombin complex, and free hemoglobin remained above reference range, and in 90% of the cases bacterial contamination was observed. Conclusions. Cardiotomy suction additionally contributes to the release of proinflammatory cytokines, activation of coagulation, and hemolysis. Becaus e blood salvage with a Haemonetics cell-saving device led to normalization of some, but not all, parameters and bacterial contamination was common, th e alternative use seems at least questionable. (C) 1999 by The Society of T horacic Surgeons.