P09 Intra‐operative Cell Salvage in Abdominal Aortic Aneurysm Repair in the South West Region

Abstract

Background The Department of Health circular, Better Blood Transfusion two requires hospitals to avoid unnecessary use of donor blood and to explore effective alternatives. The National Blood Conservation Strategy 2004 recommends that intra‐operative cell salvage (IOCS) should be considered for surgical patients where the anticipated blood loss exceeds 1000 mL. The Southwest Regional Blood Transfusion Committee selected abdominal aortic aneurysm (AAA) repair to audit the use of IOCS within the region. The aims were to identify the percentage of cases where IOCS is used and determine the reasons why IOCS is not used.Method All Trusts/hospitals in the region were invited to participate. A simple proforma was completed by theatre staff on each AAA repair for a 3 month period from November 2005 to February 2006. Co‐ordinators at each Trust/hospital returned these to the NBS Clinical Audit department for analysis.Results A total of 14 NHS Trusts/hospitals took part and only 1 eligible Trust/hospital declined to participate. All Trusts/hospitals used IOCS and in 6/14 (43%) this was used in all cases. There were 127 cases of AAA repair during the audit period and IOCS was used in 100 (79%) and not used in 27 (21%). Most cases (69%) were performed as elective procedures and in 85% IOCS was used. Emergency surgery was associated with a lower incidence of IOCS although this was still high at 72%. The most common reason for not using IOCS was lack of trained staff and this was not out of hours related. This accounted for 15 out of the 27 cases where IOCS was not used and in two Trusts/hospitals occurred in 50% or more of all cases. In the 100 cases when IOCS was used 124 units of donor red cells were transfused (average 1.24 units, range 1–15 units). In the 27 cases where IOCS was not used 102 units of donor red cells were transfused (average 3.8 units, range 1–30 units). In the 15 cases when lack of trained staff prevented IOCS, 93 donor units were transfused (average 6.2 units).Conclusions All Trusts/hospitals who participated have access to cell salvage machines. IOCS was used in 79% of all cases which compares favourably with 43% of cases reported nationally by the Vascular Society of Great Britain and Ireland 2004. Trained staff must be available for IOCS to be a valuable resource both from a clinical governance and cost‐effective perspective.