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The effects of cell salvage on systemic interleukin-6 levels and postoperative blood loss : a meta-analysis study / Beth Moe.

Cardiopulmonary bypass -- Adverse effects

Blood -- Circulation, Artificial

Inflammation Mediators.

Blood Coagulation.

Hemostasis, Surgical

Postoperative care

Extracorporeal Circulation -- methods

72 leaves : ill. ; 29 cm.

Thesis advisor: Dr. Ronald Gerrits.

Committee members: Dr. Larry Fennigkoh, Dr. John Gassert.

Introduction -- Background -- Methods -- Results -- Discussion -- References -- A: List of articles collected via literature search -- B: Category one article information -- C: Spreadsheet used to organize and calculate data from IL-6 articles -- D: Spreadsheet used to organize and calculate data pertaining to postoperative blood loss articles.

The use of cardiotomy suction has long been a part of cardiac surgery. Unfortunately, research has shown that shed pericardial blood returned through pump suction to the cardiotomy reservoir is often filled with emboli, activated platelets, and increased levels of inflammatory cytokines. In an effort to counteract this, the use of cell salvage to process shed blood during cardiac surgery has increased. Research does support that cell salvage will wash away most of the emboli and activated platelets in the shed blood, Yet it is unclear if the use of cell salvage affects certain surgical outcomes such as postoperative bleeding and transfusion requirements.

In past studies, researchers have attempted to determine the benefits of cell salvage through animal studies, clinical trials, and in vitro experiments. Overall, the results remain mixed. Most of the studies are plagued with type II errors (false negative) and low powers, caused by small sample sizes. A meta-analysis was performed with the hopes of increasing the power and reducing type II error to provide more concrete answers.

For this meta-analysis study, two dependent variables were chosen: interleukin-6 levels and postoperative bleeding. These two variables had common sample times and sampling techniques among multiple articles. They also represent potential benefits to the patient. Interleukin-6 levels are used as a marker for the extent of the inflammatory response occuring during cardiopulmonary bypass. Postoperative bleeding is an important indicator of patient hemostasis. An inadequate hemostatic state can result in re-exploratory surgery and autologous blood product transfusions.

The null hypotheses were stated as follows: H0: There is no difference in systemic interleukin-6 levels between patients in which cell salvage is used to process the shed pericardial blood and when pump suction is used to process the shed pericardial blood. H0: There is no difference in postoperative bleeding between patients in which cell salvage is used to process the shed pericardial blood and when pump suction is used to process the shed pericardial blood.

A meta-analysis was created to compare all discovered research containing adult clinical trials, written in English, of cell salvage versus cardiotomy suction (control). It was determined that the use of cell salvage reduced the interleukin-6 levels after surgery. At the end of cardiopulmonary bypass interleukin-6 levels were found to have a mean effect size of 1.91± 10.85 pg/ml. However, the mean effect sizes were not found to be statistically significant. The results for postoperative blood loss showed that the mean effect size of the postoperative bleeding at 8 hours was found to be 110.21± 18.09 ml while at 24 hours it was found to be 24.04± 113.63 ml. Significance was found to occur at the eight hour postoperative measurement.

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