#3169 EXPERIENCE IN INTRAOPERATIVE AUTOLOGOUS BLOOD SALVAGE IN PEDIATRIC CARDIAC SURGERY
Authors: Stankovic Bratislav , Vidaković Gordana , Vidaković Željko 
Published: June 2023

Abstract

Background and Aims
Due to the drastic reduction in the number of voluntary blood donors has led to the need for the development of alternative strategies for allogeneic blood transfusion, which include the use of different strategies for autologous transfusion. Display: a) the use of "Cell-Saver" pediatric cardiac surgery at the Department of Cardiothoracic Surgery, Institute for Health Protection of Mother and Child of Serbia" Dr Vukan Cupic"; b) to analyze the reduced use of allogeneic blood and /or chemo products using "Cell-Saver" pediatric cardiac surgery; c) to evaluate the "cost benefit" of this strategy (e.g. the ratio of prices "set", "Cell-Saver") and pretransfusion rates processing one unit of allogeneic blood; d) to identify increased intraoperative security in complex. reconstructive and redocardiac surgery using the "Cell-Saver" combined with ultrafiltration (conventional or modified), particularly in cyanogenic congenital heart defects, and e) to establish and improve the hemodynamic status of hemoreologic operated child.

Method
A retrospective study was conducted. Experimental group included 63 patients (aged 12 days - 16 years and 4 months, body weight of patients that ranged between 2.9 kg and 80 kg - the mean body weight was 28.3 kg). In the experimental group patients were performed following cardiac surgery: 46 patients underwent reconstructive surgery (most often reoperations for cyanogenic congenital heart defects); 3 patients who underwent cardiovascular belief, and 3 patients who underwent cardio-surgical procedures had hematological disorders. The control group included 60 patients of similar age and body mass who underwent the cardio-surgical procedure without the use of "Cell-Saver" with application of allogeneic blood and/or chemo products during transfusion care. The following laboratory parameters were accompanied: hematocrit, platelet count, fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT), after 3, 6, and 12 hours postoperatively compared to the control group. We compared the volume of postoperative bleeding by patients of the experimental group with the control group (1h, 4h, 7h, 11h, 15h, 21h and 24h) and analyzed the amount of used allogeneic and autologous blood and/or hemoglobin products used in the transfusion care during hospitalization the experimental group compared with the control group.

Results
Postoperative administration of allogeneic blood and/or hemoproducts was statistically significantly lower in the experimental group using "CellSaver" than in the control group. The amount of salvaged blood after surgery ranged from 210 ml - 620 ml. Intraoperative hematocrit "rescued" autologous blood ranged between 0.32 l / l and 0.38 l / l. e range of values preoperative and postoperative hematocrit were lower in the experimental group than in the control group that used "Cell-Saver". The total volume of postoperative drainage content was significantly lower in the experimental group, which used "Cell-Saver" compared to the control group. The postoperative hematocrit was higher in the experimental group patients who used "Cell-Saver", compared with the same operating using allogeneic blood and/or hemoproducts patients in the control group. The mean platelet count, fibrinogen, PT and aPTT results showed no statistically significant difference between the experimental group of patients in whom we used "Cell-Saver" in comparison to the control group.

Conclusion
The results obtained by the retrospective analysis of above mentioned data indicate a positive therapeutic effect of the application of the "Cell Saver" that is most common in reoperations. With the introduction of the "bell" of small volume, the use of the Cell Saver has become an integral part of the pediatric cardiac surgery - perfusion, regardless of body weight, age and body surface area of the child. The performance of intraoperative "rescue" of autologous blood using the "Cell Saver", while the follow-up of pediatric patients in the perioperative and postoperative period has immeasurable significance of teamwork perfuser, expert specialist nursing, pediatrician, cardiac surgeon and transfusion.