Title : Utilisation of intraoperative cell salvage: A single-centre retrospective analysis of use patterns and blood volume ret
Abstract:
Aims: Intraoperative cell salvage (ICS) is a strategy for optimisation of patient blood volume. There are however, associated risks such as contamination and embolism as well as an associated cost of materials and staff members. As such, guidelines recommend use of ICS based on expected blood loss between more than 500mL.(1) This study reviews use patterns of ICS across all non-cardiac surgical specialties at a single centre in Australia.
Methodology: Non-cardiac ICS from 2022-2024 was reviewed to identify indications and patterns of use. Blood volume returns were analysed to identify cases that met recommended guidelines. This was cross-referenced against the massive transfusion protocol (MTP) used to identify surgical procedures that may benefit from ICS.
Results: ICS was utilised across 168 procedures by seven surgical specialties. The most common use cases were in general surgery, vascular surgery and obstetrics. The mean blood returns per specialty varied significantly from 157mL (95%CI 92 - 223mL) in orthopaedic surgery to 1000mL (95%CI 651 - 1347mL) in vascular surgery. A total of 26% of procedures returned no blood and 70% returned <500mL. The most common procedures to return no blood were lower-uterine caesarean section (42%) and total hip replacement (32%). On review of 62 open surgical MTP activations, only 14 also utilised ICS concurrently. The most common MTP activation that did not utilise cell salvage was trauma laparotomy.
Conclusion: This review notes that blood returns in the majority of ICS cases fell below 500mL and suggests more judicious use of ICS, especially for procedures with commonly low blood return. Furthermore, cases that often require MTP activation such as trauma laparotomy may benefit from more routine ICS use.
