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Leah Y Carreo - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of Cell Saver in 2 to 3 level lumbar instrumented posterior fusions
Journal of Neurosurgery, 2018Co-Authors: Mlade Djurasovic, Charles H Crawford, Kelly R Atche, Katly E Mcgraw, Joh R Dima, Rolando M Puno, Steve D Glassma, Kirk R Owens, Leah Y CarreoAbstract:OBJECTIVEThe goal of this study was to determine efficacy and cost-effectiveness of Cell Saver in 2- and 3-level lumbar decompression and fusion.METHODSPatients seen at a tertiary care spine center who were undergoing a posterior 2- or 3-level lumbar decompression and fusion were randomized to have Cell Saver used during their surgery (CS group, n = 48) or not used (No Cell Saver [NCS] group, n = 47). Data regarding preoperative and postoperative hemoglobin and hematocrit, estimated blood loss, volume of Cell Saver blood reinfused, number of units and volume of allogeneic blood transfused intraoperatively and postoperatively, complications, and costs were collected. Costs associated with Cell Saver use were calculated based on units of allogeneic blood transfusions averted.RESULTSDemographics and surgical parameters were similar in both groups. The mean estimated blood loss was similar in both groups: 612 ml in the CS group and 742 ml in the NCS group. There were 53 U of allogeneic blood transfused in 29 patients in the NCS group at a total blood product cost of $67,688; and 38 U of allogeneic blood transfused in 16 patients in the CS group at a total blood cost of $113,162, resulting in a cost of $3031 per allogeneic blood transfusion averted using Cell Saver.CONCLUSIONSCell Saver use produced lower rates of allogeneic transfusion but was found to be more expensive than using only allogeneic blood for 2- and 3-level lumbar degenerative fusions. This increased cost may be reasonable to patients who perceive that the risks associated with allogeneic transfusions are unacceptable.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class III.
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Cell Saver for adult spinal deformity surgery reduces cost
Spine deformity, 2017Co-Authors: Jeffrey L Gum, Leah Y Carreo, Michael P Kelly, Richard A Hosti, Chessie Robinso, Douglas C Urto, David W Polly, Christophe I Shaffrey, Virginie Lafage, Frank J SchwabAbstract:Abstract Study Design Retrospective cohort. Objectives To determine if the use of Cell Saver reduces overall blood costs in adult spinal deformity (ASD) surgery. Summary of Background Data Recent studies have questioned the clinical value of Cell Saver during spine procedures. Methods ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) Cell Saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) Cell Saver available and received autologous infusion (Infusion group). Results There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of Cell Saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, Cell Saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, Cell Saver becomes cost-efficient. Conclusion Compared to transfusing allogeneic blood, Cell Saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of Cell Saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422. Level of Evidence Level III.
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predictive factors for the use of autologous Cell Saver transfusion in lumbar spinal surgery
Spine, 2013Co-Authors: Roger Kirk Owens, Charles H Crawford, Mlade Djurasovic, Chelsea E Cana, Laure O Urke, Kelly R Atche, Kathry J Mccarthy, Leah Y CarreoAbstract:Study design: Retrospective review. Objective: To identify risk factors for Cell Saver transfusion in lumbar spinal surgery and determine if Cell Saver transfusions affected intraoperative or postoperative transfusion rates. Summary of background data: Cell Saver has been used to minimize allogeneic blood transfusion in lumbar spinal surgery. Conflicting reports exist, which call into question the efficacy of Cell Saver use. Methods: We reviewed medical records of randomly selected patients who underwent posterolateral fusion with or without transforaminal interbody fusion from July 2010 to June 2011. Transfusion rates and transfusion-related complications were determined. Binary logistic regression was performed to identify risk factors for use of autologous Cell Saver transfusion. Results: There were 178 females and 107 males, with a mean age of 57.2 years. Of the 285 cases, 39 had no Cell Saver available, 147 had Cell Saver available but no autologous blood was recovered or transfused and 99 had an autologous Cell Saver transfusion. Patients who had Cell Saver transfusion had a higher rate of intraoperative allogeneic blood transfusion (52%) compared with those who did not (22%). There was no significant difference in the rate of postoperative transfusions or transfusion-related reactions between patients who did and did not have Cell Saver transfusion. Patient's age, smoking status, American Society of Anesthesiologists grade, use of anticoagulants preoperatively, primary or revision surgery, iliac crest bone graft harvest, anesthesiologist, or surgeon had no significant effect on Cell Saver infusion. Body mass index (odds ratio [OR] = 1.06), number of posterolateral fusion levels fused (OR = 2.50), and number of transforaminal interbody fusions performed (OR = 2.41) were independent risk factors for the use of autologous Cell Saver transfusion. Conclusion: Body mass index, multi-level fusion and transforaminal interbody fusion result in increased use of autologous Cell Saver transfusion in lumbar spinal surgery. Use of autologous Cell Saver transfusion did not reduce the requirement for intraoperative or postoperative allogeneic blood transfusion. Level of evidence: 2.
Jacek Karski - One of the best experts on this subject based on the ideXlab platform.
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continuous flow Cell Saver reduces cognitive decline in elderly patients after coronary bypass surgery
Circulation, 2007Co-Authors: George Djaiani, Ludwik Fedorko, Michael A Borger, Robin Green, Jo Carroll, Michael Marcon, Jacek KarskiAbstract:Background—Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with Cell Saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery. Methods and Results—A total of 226 elderly patients were randomly allocated to either Cell Saver or control groups. Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the Cell Saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (P0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups. Conclusions—The present report demonstrates that processing of shed blood with Cell Saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass. (Circulation. 2007;116:1888-1895.)
Verno T Tolo - One of the best experts on this subject based on the ideXlab platform.
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Cell Saver is it beneficial in scoliosis surgery
Journal of Children's Orthopaedics, 2007Co-Authors: Jennife M Weiss, David L Skaggs, Joh Tanne, Verno T ToloAbstract:Study design Review of the use of Cell Saver in a non-randomized group of patients undergoing spinal fusion for scoliosis.
Robe J Greenstei - One of the best experts on this subject based on the ideXlab platform.
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isolyte s a physiologic multielectrolyte solution is preferable to normal saline to wash Cell Saver salvaged blood conclusions from a prospective randomized study in a canine model
Critical Care Medicine, 1997Co-Authors: Neil A Halpe, Margarita Alicea, Uce Seabrook, A Spunge, Robe J GreensteiAbstract:Objectives The purpose of this study is to compare normal saline with Isolyte S as the wash solutions during high-volume Cell Saver autologous blood transfusion. Normal saline, the standard wash solution in Cell Saver autologous blood transfusion, is associated with acid-base and electrolyte derange
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Cell Saver autologous transfusion metabolic consequences of washing blood with normal saline
Journal of Trauma-injury Infection and Critical Care, 1996Co-Authors: Neil A Halpe, Margarita Alicea, Uce Seabrook, A Spunge, A J Mcelhinney, Robe J GreensteiAbstract:Objective : To evaluate acid-base and electrolyte changes in high volume Cell Saver autologous blood transfusion when normal saline (0.9% NaCl) is used as the wash solution. Design : Open-label study. Materials and Methods : Nine anesthetized and anticoagulated mongrel dogs underwent 15 cycles of Cell Saver autologous blood transfusion. Eight percent of the circulating blood volume (125 mL) was withdrawn, washed with normal saline, and retransfused for each cycle. Measurements and Main Results : Analyses of acid-base, electrolyte, and hematologic parameters were performed on both systemic and the washed blood. The washed blood had increased levels of sodium and chloride. There were decreased levels in pH, PCO 2 , total CO 2 (bicarbonate), lactic acid, potassium, total and ionized calcium, magnesium, inorganic phosphorus, total protein, and albumin. Systemically, in the animals, by the end of the study, there were significant increases in the levels of chloride, inorganic phosphorus, hemoglobin, and hematocrit and significant decreases in the levels of pH, total CO 2 , total and ionized calcium, magnesium, total protein, and albumin. Conclusions : Acid-base, electrolyte, and hematologic changes occur when normal saline is used as the wash solution in high volume Cell Saver autologous blood transfusion. The washed blood with its elevation of sodium and chloride appears to reflect the constituents of the wash solution, normal saline. The depletion in the washed blood of PCO 2 , total CO 2 , potassium, total calcium, ionized calcium, magnesium, phosphorus, total protein, and albumin we feel is because of the absence of these electrolytes in the wash solution and their physical removal during salvaged blood separation and washing. The systemic acid-base and electrolyte changes primarily reflect the electrolyte pattern of the reinfused washed blood except for inorganic phosphorus. Inorganic phosphorus was maintained systemically, despite its wash out in the Cell salvage process. This paradoxical finding may be caused by intraCellular to extraCellular inorganic phosphorus flux caused by the progressive systemic metabolic acidosis.
Venkatachalam Chandrasekara - One of the best experts on this subject based on the ideXlab platform.
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effects of Cell Saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on versus off cardiopulmonary bypass a randomised trial
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Gunaratnam Niranja, George Asimakopoulos, Apostolos Karagounis, Gillia Cockerill, M M Thompso, Venkatachalam ChandrasekaraAbstract:Objective: Off-pump CABG is potentially associated with reduced intraoperative blood loss and homologous blood transfusion in comparison to on-pump CABG. In this randomised controlled study we investigated the effects of autologous Cell Saver blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing CABG on- versus off-CPB. Methods: Eighty patients were randomised into one of four groups: (A) on-CPB with Cell Saver blood transfusion (CSBT), (B) on-CPB without CSBT, (C) off-pump with CSBTand (D) off-pump without CSBT. Volume of intraoperative autologous blood transfusion, postoperative mediastinal blood loss and homologous blood transfusion requirements were measured. Homologous blood was transfused when haemoglobin concentration fell below 8 g/dl postoperatively. Pre- and postoperatively prothrombin time and partial thromboplastin time were measured. Results: Preoperative patient characteristics were well matched among the four groups. The amount of salvaged mediastinal blood available for autologoustransfusion was significantly higher in the onpump group (A) compared to the off-CPB group (C) (433 155 ml vs 271 144 ml, P = 0.001). Volume of homologous blood transfusion was significantly higher in group B vs groups A, C and D (595 438 ml vs 179 214, 141 183 and 230 240 ml, respectively, P 0.05). Clotting test results revealed no significant difference between the groups. There was no significant difference in postoperative morbidity between groups. Conclusion: Off-pump CABG is associated with significant reduction in intraoperative mediastinal blood loss and homologous transfusion requirements. Autologous transfusion of salvaged washed mediastinal blood reduced homologous transfusion significantly in the on-CPB group. Cell Saver caused no significant adverse impact on coagulation parameters in on- or off-CPB CABG. Postoperative morbidity and blood loss were not affected by the use of CPB or autologous blood transfusion. We recommend the use of autologous blood transfusion in both on- and off-pump CABG surgery. # 2006 Published by Elsevier B.V.