Intraoperative cell salvage — a process in which
shed blood is collected and processed so red blood cells may be transfused back
into a patient — led to fewer transfusions and was a safe and
cost-effective alternative to allogeneic blood transfusion in trauma patients
undergoing emergency surgery, according to findings from a retrospective
matched cohort study.
From 2006 to 2007, researchers examined 47 patients in a
level I trauma center at the University Medical Center Brackenridge, in Austin,
Texas. Patients underwent an urgent operative intervention and received
intraoperative cell salvage and autologous blood transfusion. These patients
were compared with 47 sex- and age-matched patients who underwent similar
procedures but received allogeneic blood transfusion without cell salvage.
Thirty-nine patients underwent laparotomy, two underwent
thoracotomy and nine underwent orthopedic procedures.
Compared with an intraoperative blood loss of 978 mL in
patients who did not receive intraoperative cell salvage, patients who received
cell salvage had an average intraoperative blood loss of 1,795 mL but received
an average return of 819 mL of their own blood (P<.001).
Moreover, patients who received cell salvage had fewer
intraoperative and total units of allogeneic packed red blood cells when
compared with patients who did not receive the procedure (2 units vs. 4 units
during surgery and 4 units vs. 8 units total) and received less total units of
plasma (3 units vs. 5 units).
Further, the cost of blood transfusion was significantly
less in the group receiving the cell salvage procedure when compared with those
who did not receive the procedure ($1,616 vs. $2,584; P=.004).
Similar average lengths of stay in the ICU (8 days for
both) and in the hospital (18 days for the cell salvage group and 20 for the
comparison group) were observed between the two groups. No difference was
observed in mortality (13% cell salvage group vs. 21% comparison group).
The researchers recommend for further studies to
“definitively confirm the safety of transfusing contaminated blood, to
preoperatively identify patients who would most benefit from autologous
transfusion and to optimize cost-effectiveness. In the meantime, centers with
access to a cell salvage program should routinely use autologous transfusion as
part of their intraoperative resuscitation. More important, centers not
currently using intraoperative cell salvage and autotransfusion should identify
and overcome barriers to implementing this life-saving technique.”
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