Impact of Plasma Preservation in Cardiac Surgery on Acute Kidney Injury: An Unexpected Result
Robert Kramer1, *Robert Groom1, *Monica Palmeri1, *Lee Lucas2, *Crystal Heron1, *Paul Weldner3, *Scott Buchanan1, Reed Quinn1
1Maine Medical Center, Portland, ME; 2Maine Medical Center Research Institute, Portland, ME; 3Central Maine Heart and Vascular Institute, Lewiston, ME
Objective: Avoid overuse of cell saver during cardiac surgery requiring cardiopulmonary bypass (CPB) to prevent plasma loss
Design: Case matched prospective observational trial
Setting: Community hospital
Patients: Adults undergoing cardiac surgery using CPB
Interventions: Routine use of a red cell (RBC’s) saver is helpful for blood conservation but comes at the cost of plasma loss. In a single center, plasma loss was minimized by limiting cell saving to pre- and post CPB, utilizing cardiotomy suction only during CPB. A prospective cohort of 285 patients in a limited cell saver group was compared with a case-matched retrospective cohort of 268 patients where liberal use of the cell saver was practiced.
Main Outcome Measures: A case matched study design was used to compare cohorts with primary outcomes being 24 hour postoperative blood loss and transfusion requirements. Acute kidney injury (AKI) was a secondary outcome.
Results: While postoperative blood loss was the same in both groups, patients in the limited cell saver group were less likely to be transfused with RBC’s [0.73 (0.42, 1.26)], plasma [0.24 (0.11, 0.55)] and platelets [0.32 (0.15, 0.69)]. Unexpectedly, the limited cell saver group experienced significantly less postoperative AKI [0.57 (0.33, 0.97)], and when they did, was more likely to return to their baseline serum creatinine [0.59 (0.30, 1.12)] by the time of discharge.
Conclusions: Herein, plasma preservation was associated with a decrease in amount of blood products transfused and a significant decrease in the incidence of postoperative AKI. Since postoperative cardiac surgery AKI and transfusions are associated with poor short and long-term outcomes, a strategy to limit cell saver use during cardiac surgery reduces the loss of plasma and improves patient outcomes.
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