Pulmonary Implications of Filtering Various Mediators of Morbidity Found in Salvaged Blood

Abstract

Leukocyte reduction of residual circuit blood following cardiopulmonary bypass (CPB) has been demonstrated to improve lung function and reduce the inflammatory response after surgery. In this study, the effect of lipid/leuko-reduction of salvaged blood on pulmonary function and the inflammatory response was examined. Fifteen patients undergoing elective cardiac surgery were randomly assigned to a lipid/leuko-reduced group or a control group. In addition, all residual circuit blood was transferred to the autotransfusion cell-processing device at the end of CPB to contribute a significant portion of the final washed product. In the lipid/leuko-reduced group (N = 10), all processed blood was passed through a lipid globule, C3a, microaggregate pre-filter, followed by a leukocyte removing filter. In the control group (N = 5), all processed blood was filtered using a 40/150 f.lil1 dual screen transfusion filter. The lipid/leuko-reduced group showed a significant decrease in pulmonary shunt fraction following reinfusion, whereas the control group did not. The lipid/leuko-reduced group also showed a trend towards decreased pulmonary vascular resistance and a blunting of the leukocytosis that develops following the reinfusion of salvaged blood and CPB, although these trends were not statistically significant. There were no statistical differences between the two groups with respect to oxygenation index or circulating red blood cells following reinfusion. These results suggest that lipid/leuko-reducing salvaged blood improves postoperative lung function and is efficacious.