Title : Introducing intraoperative cell salvage in vascular surgery in Ethiopia: A pilot audit against UK standards
Abstract:
Background
Donor blood is a limited resource, and intraoperative cell salvage returns a patient’s own shed red cells after washing. The 2018 Association of Anaesthetists guideline recommends cell salvage routinely for all open aortic surgery, and considering it for other vascular surgery where blood loss above 500 mL is expected. Cell Saver was introduced at Tikur Anbessa Specialized Hospital in January 2026, starting with vascular surgery.
Aim: To assess whether cell salvage was used safely and in line with agreed standards in the first vascular patients, and to identify improvements before wider roll-out.
Methods: A prospective clinical audit was conducted of five consecutive adult vascular cases in which Cell Saver was set up, between 16th and 23rd January 2026. Eighteen audit standards were adapted from the 2018 guideline and the UK Cell Salvage Action Group audit proforma. Data were collected prospectively using a standardised form. Eligible cases in which Cell Saver was not used were also recorded. Compliance was assessed against applicable standards, with non-applicable criteria distinguished from unmet standards. Results were summarised descriptively as counts.
Results: Five consecutive adult vascular procedures were audited, and these were elective carotid artery aneurysm repair, elective infrarenal aortic aneurysm repair, two common iliac artery aneurysm repairs (one elective and one urgent), and symptomatic juxtarenal abdominal aortic aneurysm repair. Estimated blood loss (EBL) ranged from 600 to 1,200 mL (median 807 mL), exceeding the 500 mL guideline threshold in all five cases. Total reinfused blood volume was 2,649 mL of 4,607 mL total EBL (57.5%), with reinfused volumes ranging from 292 to 967 mL per case. No donor red-cell units were transfused in the five cases. At 24 hours, haemoglobin ranged from 8.6 to 15.8 g/dL (median 11.1), compared with 10.2–16.3 g/dL preoperatively (median 15.4). Mean haemoglobin decreased from 13.8 to 11.5 g/dL, while mean haematocrit decreased from 41.3% to 34.4%. The two largest haemoglobin decreases were 4.3 and 5.8 g/dL. One patient required reoperation for a surgical complication not associated with additional blood loss, and another experienced a perioperative complication that may have contributed to greater blood loss. The 24-hour availability standard was not met because trained staff were unavailable around the clock, consequently, two additional eligible patients did not receive cell salvage. The leucocyte-depletion filter recommendation was not clinically applicable. All other applicable standards were met.
Conclusions: Cell salvage was used without recorded equipment problems in five vascular procedures, with no donor red-cell transfusions required. These findings do not establish clinical benefit or safety. Lack of round-the-clock trained staff prevented its use in two additional eligible patients. Improving staff training and rota cover should be prioritised. Re-audit of 20–30 cases is planned for December 2026.
Keywords: cell salvage; patient blood management; vascular surgery; clinical audit; Ethiopia
