Intraoperative blood salvage in vascular surgery – worth the effort?

Julie Freischlag

doi:10.1186/cc2409

Abstract

Intraoperative autologous transfusions have been used for many years to avoid transmission of infections, especially in vascular surgery, where blood usage is considerable. Several autotransfusion devices exist, but these devices are often associated with negative outcomes such as cost, contamination, and removal of essential blood components (e.g. platelets). Preoperative autologous blood donation is another blood preservation method to avoid possible transfusion-related infections. Several vascular surgery groups have compared the use of these techniques, and their results are discussed in this review. Cell saver techniques often do not prevent the need for transfusions, nor are they very cost-effective; therefore, their use should be considered on a case-by-case basis.

Highlights

Intraoperative autologous transfusions have been used over the past 20 years as a means to avoid giving patients blood products from other individuals because of the risk of transfusion-related infections such as hepatitis and HIV
The red blood cell (RBC) washing devices are of variable capacity and design and yield RBC concentrates with different characteristics and quality [2,3]
Devices that are capable of washing RBCs are the most costly to set up and operate, but the presence of inflammatory mediators in unwashed blood and their potential to cause unwanted pulmonary and circulatory effects may justify the extra cost of washing RBCs before reinfusion

Summary

Conclusion

The use of cell salvage techniques in vascular surgery has the potential to prevent the use of homologous blood transfusions, but in reality that does not appear to occur. The risk for transmission of disease by blood transfusions is sufficiently low that the use of the Cell Saver does not appear to have an impact on the individual patient. Cost savings only occur when there is a high blood loss and a high RBC salvage rate. If the surgeon is concerned, the reservoir is the optimal method to use in cases that have the potential for high blood loss, and if excessive blood loss does occur the cell salvage device can be activated

Shulman G

Findings

Cutler BS