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Thorac Cardiovasc Surg 2007; 55(2): 68-72
DOI: 10.1055/s-2006-924655
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Interleukin-6 Enhancement after Direct Autologous Retransfusion of Shed Thoracic Blood does not Influence Haemodynamic Stability Following Coronary Artery Bypass Grafting

S. Schroeder1 , T. von Spiegel1 , F. Stuber2 , A. Hoeft2 , C. J. Preusse3 , A. Welz3 , S. Kampe4 , H. Lier4
  • 1Department of Anaesthesiology and Intensive Care Medicine, Westküstenklinikum Heide, Heide, Germany
  • 2Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
  • 3Department of Cardiac Surgery, University of Bonn, Bonn, Germany
  • 4Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
Further Information

Publication History

received Dec 13, 2005

Publication Date:
21 March 2007 (online)

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Abstract

Background: Direct autologous retransfusion of shed thoracic blood is carried out to reduce homologous transfusion after cardiac surgery, but it contains high concentrations of inflammatory mediators. The purpose of the study was to investigate whether retransfusion of shed thoracic blood induces plasma interleukin-6 (IL-6) expression and influences haemodynamics. Methods: Following uncomplicated coronary artery bypass graft surgery, forty-four patients were randomised in case postoperative blood loss via thoracic drains exceeded 350 ml. The course of plasma IL-6 levels and haemodynamics including cardiac output, extravascular lung water and intrathoracic blood volume were investigated prior to (T0), 30 minutes (T1), 1 (T2), 3 (T3) and 12 hours (T4) after retransfusion of 350 ml shed blood in comparison to 350 ml saline. Results: Plasma IL-6 levels at T1 (1892 ± 202 vs. 485 ± 30 pg/ml) and T2 (1059 ± 119 vs. 413 ± 30 pg/ml) were significantly higher in the verum group (n = 20) compared to controls (n = 24) (p < 0.01). Severe haemodynamic side effects were not detected. Conclusion: This study found significantly elevated plasma IL-6 levels following direct autologous retransfusion of shed thoracic blood but failed to show severe adverse effects affecting haemodynamic stability.

Key words

autologous blood transfusion - haemodynamic phenomena - interleukin‐6

References

  • 1 Salas M J, de Vega N, Carmona A J. et al . Autotransfusion after cardiac surgery. Hematological, biochemical, and immunological properties of shed mediastinal blood.  Rev Esp Anestesiol Reanim. 2001;  48 122-130
    PubMedSearch in Google Scholar
  • 2 Amand T, Pincemail J, Blaffart F. et al . Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit.  Perfusion. 2002;  17 117-123
    CrossrefPubMedSearch in Google Scholar
  • 3 Wei M, Kuukasjarvi P, Laurikka J. et al . Cytokine responses in low-risk coronary artery bypass surgery.  Int J Angiol. 2001;  10 27-30
    PubMedSearch in Google Scholar
  • 4 Sandoval S, Alrawi S, Samee M. et al . A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery.  Heart Surg Forum. 2001;  4 113-117
    PubMedSearch in Google Scholar
  • 5 Boelke E, Storck M, Buttenschoen K, Berger D, Hannekum A. Endotoxemia and mediator release during cardiac surgery.  Angiology. 2000;  51 743-749
    PubMedSearch in Google Scholar
  • 6 Bentzien F, Brand J M, Rohrs E, Munkel H, Schmucker P. Mechanical autotransfusion procedures. The effect of cytokines and leukocytes on washed erythrocyte concentrate.  Anaesthesist. 2000;  49 505-510
    PubMedSearch in Google Scholar
  • 7 Flom-Halvorsen H I, Ovrum E, Tangen G. et al . Autotransfusion in coronary artery bypass grafting: disparity in laboratory tests and clinical performance.  J Thorac Cardiovasc Surg. 1999;  118 610-617
    CrossrefPubMedSearch in Google Scholar
  • 8 Hansen H, Dietrich G, Kasper S M. et al . Proposals for quality management in intra- and postoperative autotransfusion.  Anästh Intensivmed. 2002;  43 81-84
    PubMedSearch in Google Scholar
  • 9 Wei M, Kuukasjarvi P, Laurikka J. et al . Cytokine responses and myocardial injury in coronary artery bypass grafting.  Scand J Clin Lab Invest. 2001;  61 161-166
    PubMedSearch in Google Scholar
  • 10 Duchow J, Ames M, Hess T, Seyfert U. Activation of plasma coagulation by retransfusion of unwashed drainage blood after hip joint arthroplasty: a prospective study.  J Arthroplasty. 2001;  16 844-849
    CrossrefPubMedSearch in Google Scholar
  • 11 Rosolski T, Mauermann K, Frick U, Hergert M. Direct autotransfusion systems deliver blood of inadequate quality.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;  35 21-24
    PubMedSearch in Google Scholar
  • 12 Hansen E. Retransfusion of autologous blood.  Anaesthesist. 2002;  51 423-424
    CrossrefPubMedSearch in Google Scholar
  • 13 Sakka S G, Ruhl C C, Pfeiffer U J. et al . Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution.  Intensive Care Med. 2000;  26 180-187
    CrossrefPubMedSearch in Google Scholar
  • 14 Godje O, Hoke K, Goetz A E. et al . Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability.  Crit Care Med. 2002;  30 52-58
    PubMedSearch in Google Scholar
  • 15 Pulsion Medical Systems .Gebrauchsanweisung PiCCO. München; Pulsion Medical Systems 2000: 4-1-4-9
    Search in Google Scholar
  • 16 Le Gall J R, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.  JAMA. 1993;  2957-2963
    CrossrefPubMedSearch in Google Scholar
  • 17 Martin J, Robitaille D, Perrault L P. et al . Reinfusion of mediastinal blood after heart surgery.  J Thorac Cardiovasc Surg. 2000;  120 499-504
    CrossrefPubMedSearch in Google Scholar
  • 18 Vertrees R A, Conti V R, Lick S D. et al . Adverse effects of postoperative infusion of shed mediastinal blood.  Ann Thorac Surg. 1996;  62 717-723
    CrossrefPubMedSearch in Google Scholar
  • 19 Peivandi A A, Dahm M, Vulcu S. et al . Troponin I concentrations of shed blood might influence monitoring of myocardial injury after coronary operations.  Transfus Apheresis Sci. 2001;  25 157-162
    CrossrefPubMedSearch in Google Scholar
  • 20 Andersson I, Tylman M, Bengtson J P, Bengtsson A. Complement split products and pro-inflammatory cytokines in salvaged blood after hip and knee arthroplasty.  Can J Anaesth. 2001;  48 251-255
    PubMedSearch in Google Scholar
  • 21 Krohn C D, Reikeras O, Aasen A O. Inflammatory cytokines and their receptors in arterial and mixed venous blood before, during and after infusion of drained untreated blood.  Transfus Med. 1999;  9 125-130
    CrossrefPubMedSearch in Google Scholar
  • 22 Schmidt H, Bendtzen K, Mortensen P E. The inflammatory cytokine response after autotransfusion of shed mediastinal blood.  Acta Anaesthesiol Scand. 1998;  42 558-564
    PubMedSearch in Google Scholar
  • 23 Arnestad J P, Bengtsson A, Bengtson J P. et al . Formation of cytokines by retransfusion of shed whole blood.  Br J Anaesth. 1994;  72 422-425
    CrossrefPubMedSearch in Google Scholar
  • 24 Hansen E, Hansen M P. Reasons against the retransfusion of unwashed wound blood.  Transfusion. 2004;  44 45S-53S
    CrossrefPubMedSearch in Google Scholar
  • 25 Handel M, Winkler J, Hornlein R F. et al . Increased interleukin-6 in collected drainage blood after total knee arthroplasty: an association with febrile reactions during retransfusion.  Acta Orthop Scand. 2001;  72 270-272
    CrossrefPubMedSearch in Google Scholar
  • 26 Dinse H, Deusch H. Sepsis following autologous blood transfusion.  Anaesthesist. 1996;  45 460-463
    CrossrefPubMedSearch in Google Scholar
  • 27 Arnold J P, Haeger M, Bengtson J P, Bengtsson A, Lisander B. Release of inflammatory mediators in association with collection of wound drainage blood during orthopaedic surgery.  Anaesth Intensive Care. 1995;  23 683-686
    PubMedSearch in Google Scholar
  • 28 Bengtsson A, Avall A, Hyllner M, Bengtson J P. Formation of complement split products and proinflammatory cytokines by reinfusion of shed autologous blood.  Toxicol Lett. 1998;  100 - 101 129-133
    CrossrefPubMedSearch in Google Scholar
  • 29 Kitano T, Hattori S, Miyakawa H. et al . Unwashed shed blood infusion causes deterioration in right ventricular function after coronary artery surgery.  Anaesth Intensive Care. 2000;  28 642-645
    PubMedSearch in Google Scholar
  • 30 Rosolski T. Autologous transfusion - from euphoria to reason: clinical practice based on scientific knowledge (Part II). Autologous direct re-transfusion - contra.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;  39 697-700
    Thieme ConnectPubMedSearch in Google Scholar

MD Heiko Lier

Department of Anaesthesiology and Intensive Care Medicine
University of Cologne

Kerpener Straße 62

50937 Köln

Germany

Phone: + 49 22 14 78 48 07

Fax: + 49 22 14 78 60 93

Email: heiko.lier@uk-koeln.de