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Präoperative Eigenblutspende in der Herzchirurgie

Reduzierung des Fremdblutverbrauches

Preoperative autologous blood donation in cardiac surgery

Reduction of allogeneic blood requirements

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Zusammenfassung

Hintergrund

Die präoperative Eigenblutspende (EBS) ist eine effektive Methode zur Reduzierung des Fremdblutverbrauches. Dennoch findet sie nur vereinzelt Anwendung in der Herzchirurgie. Ein wesentliches Argument gegen die EBS ist die fehlende Zeit zur Durchführung. Ziel der Studie war die Untersuchung der Effektivität der präoperativen EBS bei kardiochirurgischen Routineeingriffen an einem Herzzentrum ohne längere präoperative Wartezeiten.

Methode

Die Daten von 2626 erwachsenen kardiochirurgischen Patienten wurden bezüglich der Inzidenz einer Transfusion allogener Erythrozytenkonzentrate analysiert. Primärer Endpunkt war die Transfusionshäufigkeit allogener Erythrozytenkonzentrate. Wenn die Zeitspanne zwischen Operationsanmeldung und Krankenhauseinweisung mehr als 10 Tage betrug, wurde allen Patienten die Möglichkeit zur präoperativen EBS angeboten. Die Auswertung erfolgte stratifiziert nach dem präoperativen Operationsrisiko. Mit logistischer bzw. linearer Regressionsanalyse wurde der Einfluss unterschiedlicher Faktoren auf die Variablen Fremdblut ja/nein und Gesamtmenge Fremdblut getestet.

Ergebnis

Es spendeten 267 Patienten (11,2%) präoperativ Eigenblut. Die Inzidenz allogener Transfusionen wurde durch die präoperative EBS von 53% auf 19% reduziert (p<0,01). Dieser Unterschied blieb auch nach der Stratifizierung nach Operationsrisiko signifikant. Die Gesamtmenge allogener Erythrozytenkonzentrate pro Patient war statistisch signifikant unterschiedlich (2,2±4,2 in der Kontrollgruppe vs. 0,84±6,3 Einheiten in der Eigenblutgruppe; p<0,001).

Schlussfolgerungen

Die präoperative EBS lässt sich auch unter Bedingungen kurzer Wartezeiten in der Herzchirurgie als effektive Methode zur Reduzierung des Fremdblutverbrauches einsetzen.

Abstract

Background

Preoperative autologous blood donation is an effective method to reduce allogeneic transfusion requirement. However, this method is only rarely utilized in cardiac surgery. Besides economic concerns one essential argument against predonation is the lack of sufficient time due to the short waiting lists. The aim of the present study was to investigate the efficacy of autologous predonation to reduce allogeneic blood transfusion in routine cardiac surgery on a center without longer preoperative waiting lists.

Patients and methods

A total of 2,626 cardiac surgery patients were included. Primary endpoint of the study was the perioperative incidence of allogeneic packed cell transfusion. If time between diagnosis and admission to the hospital was >10 days, predonation was offered to the patients. Data were stratified for preoperative risk score. Logistic and linear regression analysis tested the influence of different variables on the incidence of allogeneic blood transfusion and the total amount of allogeneic blood.

Results

Of all patients 267 (11.2%) underwent predonation. The incidence of allogeneic packed cell transfusion was reduced from 53% to 19% by autologous predonation (p<0.001). The total amount of allogeneic blood transfused was significantly different between the groups (2.2±4.2 vs. 0.84±6.3 units; p<0.001).

Discussion

Autologous predonation in cardiac surgery was effective in reducing blood transfusions even in the absence of longer preoperative waiting times. It is a safe and effective method to minimize blood transfusion in cardiac surgery.

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Authors and Affiliations

  1. Institut für Anästhesiologie, Deutsches Herzzentrum, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München

    W. Dietrich & R. Busley

  2. Institut für medizinische Statistik und Epidemiologie (IMSE), Technische Universität München

    M. Kriner

Authors
  1. W. Dietrich
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  2. R. Busley
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  3. M. Kriner
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Correspondence to W. Dietrich.

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Dietrich, W., Busley, R. & Kriner, M. Präoperative Eigenblutspende in der Herzchirurgie. Anaesthesist 55, 753–759 (2006). https://doi.org/10.1007/s00101-006-1035-2

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  • DOI: https://doi.org/10.1007/s00101-006-1035-2

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