This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Randomized controlled trial of acute normovolaemic haemodilution in aortic aneurysm repair. BJS 2001; 88: 603-604.
Published: 6th December 2002
Authors: L. Wolowczyk, R. A. Bulbulia, A. Stewart, M. Nevin, A. Day, F. C. T. Smith et al.
Background
Previous studies have suggested that acute normovolaemic haemodilution (ANH) reduces the need for heterologous blood transfusion in abdominal aortic aneurysm (AAA) surgery and may thus improve postoperative outcome by reducing the systemic inflammatory response. Controlled studies are lacking. The aim of this randomized controlled trial was to evaluate the effects of ANH on the systemic inflammatory response, clinical outcome and use of bank blood after AAA repair.
Method
Patients undergoing elective AAA repair were randomized to ANH (n = 16) or control (n = 18) groups. Intraoperative cell salvage and heterologous blood were used in both groups according to predetermined transfusion triggers. Inflammatory markers in serum and urine were measured to assess the acute‐phase response. Clinical outcome was determined using mortality, morbidity and the incidence of the systemic inflammatory response syndrome (SIRS).
Results
There was no difference between the ANH and control group in serial measurements of median (range) white cell count (maximum at 2 days after operation: 11·9 (7·7–21·4) versus 10·3 (7·8–20·6) × 109 l−1; P = 0·25), serum C‐reactive protein level (maximum at 3 days: 150 (1–274) versus 169 (7–238) mg ml−1; P = 0·76), interleukin 6 level (maximum at 6 h: 142 (32–793) versus 105 (29–509) pg ml−1; P = 0·89), total antioxidant capacity (lowest at 1 h: 0·83 (0·67–1·22) versus 0·83 (0·68–1·23) mmol l−1; P = 0·45) or urinary albumin/creatinine ratio (maximum at 30 min after clamp release: 41 (2–923) versus 124 (4–376) mg ml−1; P = 0·10). SIRS was observed in ten of 16 patients having ANH and in 11 of 18 control patients (P = 0·99). There was no significant difference in mortality and morbidity between the groups. Similarly, there was no difference in median (range) blood loss (ANH 1800 (400–12 000) ml versus control 1600 (500–7500) ml; P = 0·55), use of cell salvage (600 (0–4740) versus 520 (0–2420) ml; P = 0·60) or heterologous blood transfusion (2 (0–32) versus 2 (0–9) units; P = 0·68).
Conclusion
In the setting of a randomized controlled trial ANH added no additional benefit, when used in combination with cell salvage, in reducing the requirements for heterologous blood transfusion, and made no impact on systemic inflammatory response and clinical outcome after AAA repair. © 2001 British Journal of Surgery Society Ltd
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