Randomized clinical trial of intraoperative autotransfusion in surgery for abdominal aortic aneurysm

Abstract

Perioperative homologous blood transfusion (HBT) is associated with adverse reactions and risks transmission of infection. It has also been implicated as an immunosuppressive agent. Intraoperative autotransfusion (IAT) is a potential method of autologous transfusion. This was a single-centre randomized clinical trial of IAT in surgery for abdominal aortic aneurysm. Forty patients were randomized to IAT and 41 underwent surgery with HBT only. Patients in both groups received HBT to maintain haemoglobin levels above 8 g/dl. Transfusion requirements, and incidence of systemic inflammatory response syndrome (SIRS) and infection, were compared. Significantly fewer patients in the IAT group required HBT (21 versus 31; P = 0.038) and the median blood requirement per patient was 2 units lower (P = 0.012). There was a higher incidence of chest infection (12 versus four patients; P = 0.049) and SIRS (20 versus nine patients; P = 0.020) in the HBT group. Risk of SIRS was related to aortic cross-clamp time in the IAT group only. Use of autotransfusion effectively reduced the need for HBT and was associated with a reduced incidence of postoperative SIRS and infective complications.