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Smith NK, Kim SJ, Simmons Q, Lin HM, Romano D, Boydston E, DeMaria S, Zerillo J. The Optimal Cell Salvage Settings to Maximize Hematocrit and Minimize Potassium Using the Cobe BRAT2 Autologous Blood Recovery Unit. J Cardiothorac Vasc Anesth 2021; 36:1893-1900. [PMID: 34446326 DOI: 10.1053/j.jvca.2021.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective was to determine the optimal cell saver device settings (infusion rate and wash rate) at which hematocrit is preserved and potassium and lactate are removed from banked red blood cells (RBC). DESIGN Red cells were washed using the Cobe BRAT 2 Autologous Blood Recovery Unit and sampled for electrolyte composition and hematocrit pre- and postwash. SETTING This was a single-center study. INTERVENTIONS Red cells were washed using six infusion rates (100-1,000 mL/min) and six wash rates (100-1,000 mL/min) for a total of 36 combinations. Hematocrit, potassium, glucose, and lactate were evaluated before and after washing. MEASUREMENTS AND MAIN RESULTS At wash rates ≤400 mL/min, hematocrit increased independent of infusion rate. At wash rates ≥400 mL/min, slower infusion rates were associated with higher hematocrit compared to faster infusion rates (p < 0.0001 for a wash rate 400-800 mL/min, p < 0.0005 for a wash rate 1,000 mL/min). Maximal wash speeds were associated with decreasing hematocrit. Infusion and wash rate were both independent predictors of potassium change; slower rates were associated with a larger decrease in potassium. Glucose decreased proportionally as infusion and wash rate decreased. Lactate did not show an association with either infusion or wash rate. CONCLUSION Red-cell washing produces higher hematocrit and lower potassium as infusion rate and wash rate decrease. A 340-mL unit of RBC can be processed in 4.26 minutes without loss of hematocrit or an increase in potassium when both infusion and wash rates are set to 400 mL/min.
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Affiliation(s)
- Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Sang J Kim
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York
| | - Qasim Simmons
- Cardiovascular Perfusion Services, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diana Romano
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elaine Boydston
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at, UCLA, Los Angeles, CA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeron Zerillo
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Intraoperative Cell Saving: Is the Solution the Actual Problem? THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2021; 53:62-67. [PMID: 33814608 DOI: 10.1182/ject-2000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/28/2021] [Indexed: 11/20/2022]
Abstract
Allogenic blood is a scarce, precious, and expensive resource that is not always available on demand. After termination of cardiopulmonary bypass, a large amount of residual pump blood remains in the extracorporeal circuit. The cell saver washes and concentrates this blood with .9% normal saline (NS), making autologous blood available and reducing the demand for allogenic blood. To quantify the quality of residual pump blood it was washed with either NS or a bicarbonate-buffered solution (Balsol). A qualitative in vitro analysis was conducted. Residual cardiopulmonary bypass blood from forty bypass circuits was processed with a cell saver device, using NS or Balsol solution. Measurements made compared the pH, electrolytes, metabolites, hematocrit, hemoglobin, osmolality, albumin, total protein, and strong ion difference. There were significant differences between the NS and Balsol groups. In the Balsol group, osmolality, electrolytes, and strong ion difference were similar to the constitution of Balsol solution after washing, but not with the normal saline group. Washing residual cardiopulmonary bypass pump blood with Balsol solution results in a resuspended red cell concentrate with a superior electrolyte profile and a strong ion difference similar to that of residual pump blood.
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Hofbauer N, Windberger U, Schwendenwein I, Tichy A, Eberspächer E. Evaluation of canine red blood cell quality after processing with an automated cell salvage device. J Vet Emerg Crit Care (San Antonio) 2016; 26:373-83. [DOI: 10.1111/vec.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/29/2014] [Accepted: 10/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nina Hofbauer
- Department of Anesthesiology and Perioperative Intensive Care; University of Veterinary Medicine; Vienna Austria
| | - Ursula Windberger
- Decentralized Biomedical Facilities of the Medical University of Vienna; Vienna Austria
| | - Ilse Schwendenwein
- Department of Pathobiology, Central Laboratory; University of Veterinary Medicine; Vienna Austria
| | - Alexander Tichy
- Department of Biomedical Sciences; University of Veterinary Medicine; Vienna Austria
| | - Eva Eberspächer
- Department of Anesthesiology and Perioperative Intensive Care; University of Veterinary Medicine; Vienna Austria
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Huber D, Witt L, Sümpelmann R, Heinze L, Müller T, Lichtinghagen R, Osthaus WA. Comparison of bicarbonate-buffered fluid and isotonic saline solution as Cell Saver washing fluids for packed red blood cells. Paediatr Anaesth 2013; 23:1021-6. [PMID: 23910018 DOI: 10.1111/pan.12232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Massive transfusion (MT) can cause severe electrolyte and acid-base disturbances in neonates and infants due to the unphysiological composition of packed red blood cells (PRBCs). Washing of the PRBCs using Cell Saver systems prior to MT is recommended for this reason. AIM The composition of normal saline (NaCl), the standard wash fluid for Cell Saver systems, is considerably different from that of physiological plasma. The aim of the study presented here was to investigate the effect of washing the PRBCs with a bicarbonate-buffered hemofiltration solution (BB-HS) in comparison with washing with NaCl and to evaluate the impact on electrolyte concentrations, acid-base balance and the stability of PRBCs. METHODS In an experimental in vitro setting, PRBCs were washed with Cell Saver systems prepared with NaCl or BB-HS as washing solutions. Before and after the washing procedure, electrolyte concentrations, acid-base parameters, adenosine triphosphate (ATP) and free hemoglobin (fHb) concentrations were measured. RESULTS In both groups, the potassium concentrations decreased (baseline: 18.4 ± 5.17 mmol·l(-1), end of study: NaCl 2.71 ± 1,81 mmol·l(-1), BB-HS 2.50 ± 1.54 mmol·l(-1), P < 0.05) while the acid-base balance improved only in the BB-HS-group (baseline: base excess -21.6 ± 3.52 mmol·l(-1), end of study: NaCl -30.2 ± 1.42 mmol·l(-1), BB-HS -7.51 ± 2.49 mmol·l(-1) , P < 0.05). Furthermore, markers of erythrocyte stability such as fHb and ATP concentrations were improved in the BB-HS-group. CONCLUSIONS Washing of PRBCs with BB-HS rather than NaCl results in a more physiological composition with improvements of electrolyte concentrations, acid-base balance and erythrocyte stability.
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Affiliation(s)
- Dirk Huber
- Department of Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
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Hamid ZA, Blencowe A, Ozcelik B, Palmer JA, Stevens GW, Abberton KM, Morrison WA, Penington AJ, Qiao GG. Epoxy-amine synthesised hydrogel scaffolds for soft-tissue engineering. Biomaterials 2010; 31:6454-67. [DOI: 10.1016/j.biomaterials.2010.05.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/07/2010] [Indexed: 12/27/2022]
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Bai SJ, Lee JW, Lee KY. Fluid therapy: classification and characteristics of intravenous fluids. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.12.1103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Sun Joon Bai
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Wha Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki-Young Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Swindell CG, Barker TA, McGuirk SP, Jones TJ, Barron DJ, Brawn WJ, Horsburgh A, Willetts RG. Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease. Eur J Cardiothorac Surg 2007; 31:659-64. [PMID: 17291775 DOI: 10.1016/j.ejcts.2007.01.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 11/19/2006] [Accepted: 01/06/2007] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. METHODS The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n=11) received unwashed irradiated red cells and the study group (n=11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. RESULTS Washing irradiated red cells reduced donor blood [potassium] from>20 to 0.8+/-0.1mmol/l, and [lactate] from 13.7+/-0.5 to 5.0+/-0.3mmol/l (p<0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6+/-0.1 vs 8.1+/-0.4mmol/l, p<0.001; lactate 2.6+/-0.2 vs 4.6+/-0.3mmol/l, p<0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9+/-0.3mmol/l) and during rewarming (4.9+/-0.4mmol/l). These were significantly higher than the washed group (3.1+/-0.1, p<0.001 and 3.0+/-0.1mmol/l, p<0.001). The [potassium] was greater than 6.0mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately post-bypass the washed group had significantly lower serum [potassium] (3.2+/-0.1 vs 4.2+/-0.2mmol/l, p=0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. CONCLUSIONS The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease.
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Abstract
This article describes the intraoperative washed cell salvage process and principles of cell salvage technology and addresses the parameters that can maximize the effectiveness of the process. Used appropriately, this technique can be used to recover and readminister several blood volumes of red cells.
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Affiliation(s)
- Jonathan H Waters
- Department of Anesthesiology, Magee Women's Hospital of the University of Pittsburgh Medical Center, Suite 3510, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Tan HP, Madeb R, Kovach SJ, Orloff M, Mieles L, Johnson LA, Bozorgzadeh A, Marcos A. Hypophosphatemia after 95 right-lobe living-donor hepatectomies for liver transplantation is not a significant source of morbidity. Transplantation 2003; 76:1085-8. [PMID: 14557757 DOI: 10.1097/01.tp.0000085652.47821.8a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypophosphatemia appears to be a universal event after right hepatic lobectomy for live-donor adult liver transplantation according to one report. Because hypophosphatemia appears to contribute to increased postoperative complications, routine hyperalimentation with supratherapeutic levels of phosphorus was advocated. METHODS From July 2000 to May 2002, we performed 95 right-lobe living-donor hepatectomies for 95 adult liver-transplant recipients, the largest single institutional experience. We reviewed our data that were collected prospectively. RESULTS We did not find profound hypophosphatemia (<1.0 mg/dL) to be prevalent in our donors. At least six (6.3%) donors did not have postoperative hypophosphatemia. In addition, there appears to be no increased morbidity related to hypophosphatemia when aggressively corrected with intravenous or oral phosphates in our group of donors that underwent right-lobe hepatectomies. CONCLUSIONS We, therefore, cannot endorse the routine administration of hyperalimentation with supratherapeutic phosphorus because of its potential morbidity.
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Affiliation(s)
- Henkie P Tan
- Thomas E. Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Esler MD, Douglas MJ. Planning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:127-44, vii. [PMID: 12698837 DOI: 10.1016/s0889-8537(02)00027-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obstetric hemorrhage continues to be a significant cause of maternal mortality and morbidity. Blood transfusion in such circumstances may be life saving but involves exposing the patient to additional risks. Limiting blood transfusion and using autologous blood when possible may reduce some of these risks. This article outlines the techniques that may be used to limit and more effectively treat hemorrhage in the obstetric patient, with particular attention paid to reducing the use of allogeneic blood transfusion.
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Affiliation(s)
- Mark D Esler
- Department of Anesthesia, Division of Obstetric Anesthesia, University of British Columbia, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada.
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Sümpelmann R, Schürholz T, Thorns E, Hausdörfer J. Acid-base, electrolyte and metabolite concentrations in packed red blood cells for major transfusion in infants. Paediatr Anaesth 2001; 11:169-73. [PMID: 11240874 DOI: 10.1046/j.1460-9592.2001.00637.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
METHODS Acid-base, electrolyte and metabolite concentrations were determined in 100 U of packed red blood cells (RBC) preserved in extended-storage media to be used for major transfusion in paediatric and cardiac surgery. RESULTS In fresh RBC, low pH, bicarbonate (cHCO3-), base excess (BE) and high glucose values were observed all outside the physiological range. With lengthening storage duration, values of pH, cHCO3-, BE, sodium and glucose decreased and carbon dioxide, potassium and lactic acid concentrations increased [mean +/- SD (range): storage duration 6.7 +/- 3.8 (1-17) days, pH 6.79 +/- 0.1 (6.53-6.99); mmol.l-1: cHCO3- 11.1 +/- 1.5 (6.2-14.5), BE - 29.2 +/- 4.1 ([-39.4] - [-20.9]), potassium 20.5 +/- 7.8 (4.2-43.6), glucose 24.1 +/- 6.1 (16.7-29.2), lactic acid 9.4 +/- 4 (4.3-21.4)]. CONCLUSION Massive and rapid transfusion of RBC may lead to a severe burden of hydrogen ions, carbon dioxide, potassium, glucose and lactic acid and this can be avoided by cell saver blood processing, when autologous erythrocytes from the operative field are saved and substrate load and storage lesions from packed red blood cells are minimized in one step by washing.
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Affiliation(s)
- R Sümpelmann
- Anästhesie III, OE 8060, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany.
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