1. Gethin Boyle St Thomas’ Hospital
A comparison of haemostatic biomarkers in low-risk patients undergoing cardiopulmonary bypass using either conventional centrifugal cell salvage or the HemoSep device

2. Conventional cell saver vs. HemoSep during cardiopulmonary bypass.
Background
Approximately 1600 CPB cases/year
100+ ECMO
RPB processing in the UK
Pro’s
Raise Hb & Hct
Reduces allogenic blood usage
Cost saving
Plasma proteins, clotting factors & platelets
(Issitt & Sheppard 2011)
Con’s
Potential of fluid overload
Inflammatory mediators
Surgical debris
Bacteriological contamination

3. HemoSep Device Advancis Surgical
Orbital agitator (120cpm)
Suction aspiration unit
Collection reservoir and pump
Processing and transfusion bags
Polyvinyl chloride blood bag
Polycarbonate control membrane filter (1μm)
12g Superadsorber pad (240mL/g)

4. HemoSep Device (Gunaydin & Gourlay, 2013)

5. Methods RCT Sorin Xtra (control group) HemoSep (study group)
54 patients (n = 28 control, n = 26 study)
1st time CABG & AVR
Granted full R&D, NRES and REC approval
Bloods taken
Pre operatively during anaesthesia
Prior to weaning from CPB
Post re-transfusion of cell saved blood
3hrs post operatively
FBC (RBC, WBC, Hb, Hct, Plt, MPV & PDW)
Clotting screen (PT, aPTT & Fibrinogen)
D Dimers
Platelet function
Endogenous Thrombin Potential (ETP)

6. Results Surgical data

7. Results FBC’s

8. Results Clotting screens

9. Results ETP

10. Conclusion
Returning whole blood is of little benefit in terms of coagulation with low risk CPB cases.
In larger volumes of blood, the HemoSep device could be beneficial as shown by the shorter prothrombin time, ETP and D- dimer levels suggesting there is less activation of coagulation and fibrinolysis. Further work is needed to confirm this.
It remains to be determined whether conventional centrifugal cell salvage removes more cytokines, plasma-free haemoglobin, surgical debris and bacteriological contamination.
More vigilant approach in measuring ACT post-transfusion may be required.
In large volumes, centrifugation may not only cause a dilutional coagulopathy, but also instigate a consumption coagulopathy.