Adverse effects of postoperative infusion of shed mediastinal blood

Roger A. Vertrees, Vincent Conti, Scott D. Lick, Joseph B. Zwischenberger, Laura B. McDaniel, Gerald Shulman

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background. Postoperative infusion of shed mediastinal blood has been used in an effort to decrease blood usage after cardiac operations. Recent experience has suggested that this practice may actually lead to a delayed increase in bleeding. Methods. In a prospective, randomized study, 40 patients undergoing coronary artery bypass grafting with shed mediastinal blood collected in a cardiotomy reservoir were divided into two equal groups and studied during their first 4 hours in the intensive care unit. Shed mediastinal blood was directly infused in group I (n = 20), whereas in group II (n = 20), it was not. In group II, if a sufficient volume of red cells was present to allow processing (n = 5), washed red cells were infused. Variables studied before and after infusion were the amount of blood lost and infused, homologous blood transfused, complete blood count and differential, serum fibrinogen, fibrin split products, D-dimers, clotting factors, prothrombin time, activated partial thromboplastin time, thromboelastograms, plasma-free hemoglobin, complement factors C3 and C4, creatine kinase and its MB isoenzyme, and body temperature. Results. After infusion of shed mediastinal blood, elevated levels of fibrin split products and D-dimers were found in significantly more patients in group I. The thromboelastogram index was normal in 76% of patients in group II but in only 12.5% in group I. Group I also had an increase in band neutrophils, a greater number of febrile patients, higher serum levels of creatine kinase, its MB isoenzyme, and plasma-free hemoglobin, and greater blood loss during hours 3, 4, and 5 in the intensive care unit. The volume of red cells in shed mediastinal blood (hematocrit, 9% to 10%) was small, resulting in clinically insignificant autotransfusion when infused directly, and insufficient for cell processing in most patients. Conclusions. These data support those in previous studies that direct infusion of shed mediastinal blood does not save substantial amounts of autologous red cells and can cause a delayed coagulopathy and other adverse effects that may be harmful to patients postoperatively.

Original languageEnglish (US)
Pages (from-to)717-723
Number of pages7
JournalAnnals of Thoracic Surgery
Volume62
Issue number3
DOIs
StatePublished - Sep 1996

Fingerprint

MB Form Creatine Kinase
Cell Size
Isoenzymes
Intensive Care Units
Hemoglobins
Complement C4
Fibrin Fibrinogen Degradation Products
Autologous Blood Transfusions
Complement C3
Blood Coagulation Factors
Blood Cell Count
Partial Thromboplastin Time
Prothrombin Time
Fibrin
Body Temperature
Serum
Hematocrit
Coronary Artery Bypass
Neutrophils
Fever

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Vertrees, R. A., Conti, V., Lick, S. D., Zwischenberger, J. B., McDaniel, L. B., & Shulman, G. (1996). Adverse effects of postoperative infusion of shed mediastinal blood. Annals of Thoracic Surgery, 62(3), 717-723. https://doi.org/10.1016/S0003-4975(96)00390-6

Adverse effects of postoperative infusion of shed mediastinal blood. / Vertrees, Roger A.; Conti, Vincent; Lick, Scott D.; Zwischenberger, Joseph B.; McDaniel, Laura B.; Shulman, Gerald.

In: Annals of Thoracic Surgery, Vol. 62, No. 3, 09.1996, p. 717-723.

Research output: Contribution to journalArticle

Vertrees, RA, Conti, V, Lick, SD, Zwischenberger, JB, McDaniel, LB & Shulman, G 1996, 'Adverse effects of postoperative infusion of shed mediastinal blood', Annals of Thoracic Surgery, vol. 62, no. 3, pp. 717-723. https://doi.org/10.1016/S0003-4975(96)00390-6
Vertrees, Roger A. ; Conti, Vincent ; Lick, Scott D. ; Zwischenberger, Joseph B. ; McDaniel, Laura B. ; Shulman, Gerald. / Adverse effects of postoperative infusion of shed mediastinal blood. In: Annals of Thoracic Surgery. 1996 ; Vol. 62, No. 3. pp. 717-723.
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abstract = "Background. Postoperative infusion of shed mediastinal blood has been used in an effort to decrease blood usage after cardiac operations. Recent experience has suggested that this practice may actually lead to a delayed increase in bleeding. Methods. In a prospective, randomized study, 40 patients undergoing coronary artery bypass grafting with shed mediastinal blood collected in a cardiotomy reservoir were divided into two equal groups and studied during their first 4 hours in the intensive care unit. Shed mediastinal blood was directly infused in group I (n = 20), whereas in group II (n = 20), it was not. In group II, if a sufficient volume of red cells was present to allow processing (n = 5), washed red cells were infused. Variables studied before and after infusion were the amount of blood lost and infused, homologous blood transfused, complete blood count and differential, serum fibrinogen, fibrin split products, D-dimers, clotting factors, prothrombin time, activated partial thromboplastin time, thromboelastograms, plasma-free hemoglobin, complement factors C3 and C4, creatine kinase and its MB isoenzyme, and body temperature. Results. After infusion of shed mediastinal blood, elevated levels of fibrin split products and D-dimers were found in significantly more patients in group I. The thromboelastogram index was normal in 76{\%} of patients in group II but in only 12.5{\%} in group I. Group I also had an increase in band neutrophils, a greater number of febrile patients, higher serum levels of creatine kinase, its MB isoenzyme, and plasma-free hemoglobin, and greater blood loss during hours 3, 4, and 5 in the intensive care unit. The volume of red cells in shed mediastinal blood (hematocrit, 9{\%} to 10{\%}) was small, resulting in clinically insignificant autotransfusion when infused directly, and insufficient for cell processing in most patients. Conclusions. These data support those in previous studies that direct infusion of shed mediastinal blood does not save substantial amounts of autologous red cells and can cause a delayed coagulopathy and other adverse effects that may be harmful to patients postoperatively.",
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