Cell salvage in emergency trauma surgery: Cochrane systematic review
Trauma is the leading cause of death in people under the age of 45 years. Over the past 20 years, intraoperative autologous transfusions (obtained by cell salvage, also known as intraoperative blood salvage (IBS)) have been used as an alternative to blood products from other individuals during surgery because of the risk of transfusion-related infections such as hepatitis and human immunodeficiency virus (HIV). In this review, we sought to assess the effects and cost of cell salvage in individuals undergoing abdominal or thoracic surgery.Objectives
To compare the effect and cost of cell salvage with those of standard care in individuals undergoing abdominal or thoracic trauma surgery.Search methods
We ran the search on 25 November 2014. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid OLDMEDLINE, EMBASE Classic + EMBASE (OvidSP), PubMed, and ISI Web of Science (SCI-Expanded & CPSI-SSH). We also screened reference lists and contacted principal investigators.Selection criteria
Randomised controlled trials comparing cell salvage with no cell salvage (standard care) in individuals undergoing abdominal or thoracic trauma surgery.Data collection and analysis
Two authors independently extracted data from the trial reports. We used the standard methodological procedures expected by The Cochrane Collaboration.Main results
Only one small study (n = 44) fulfilled the inclusion criteria. Results suggested that cell salvage did not affect mortality overall (death rates were 67% (14/21 participants) in the cell salvage group and 65% (15/23) in the control group) (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.31 to 3.72). For individuals with abdominal injury, mortality was also similar in both groups (OR 0.48, 95% CI 0.11 to 2.10).
Less donor blood was needed for transfusion within the first 24 hours postinjury in the cell salvage group compared with the control group (mean difference (MD) -4.70 units, 95% CI -8.09 to -1.31). Adverse events, notably postoperative sepsis, did not differ between groups (OR 0.54, 95% CI 0.11 to 2.55). Cost did not notably differ between groups (MD -177.81, 95% CI -452.85 to 97.23, measured in GBP in 2002).Authors' conclusions
Evidence for the use of cell salvage in individuals undergoing abdominal or thoracic trauma surgery remains equivocal. Large, multicentre, methodologically rigorous trials are needed to assess the relative efficacy, safety and cost-effectiveness of cell salvage in different surgical procedures in the emergency context.
Li Jiang, Sun Shao Liang, Tian Jin Hui, Yang KeHu, Liu Ruifeng, Li Jun
In people undergoing emergency surgery to the chest or abdomen, how effective is transfusing a person's own blood compared with donor blood
Trauma is the leading cause of death in people under the age of 45 years. Over the past 20 years, transfusions using an individual's own blood, salvaged during surgery through a process called 'cell salvage' (also known as intraoperative blood salvage), have been used as an alternative to blood products donated from other individuals (standard care) during surgical procedures. Many people prefer this because of the risk of transfusion-related infections such as hepatitis and human immunodeficiency virus (HIV) from donor blood. In this review, we aimed to determine how effective cell salvage is, compared with usual care, in individuals undergoing abdominal or thoracic (chest) trauma surgery. We considered outcomes including the survival of the individual, their need for extra blood and the costs of this procedure compared with standard care.
Evidence in this review is current to 25 November 2014.
We identified one randomised controlled trial, which involved people with a penetrating injury to the chest. In this study, 44 people (mostly male and with similar characteristics in terms of type of injury) were given either their own reprocessed blood (through cell salvage) or standard care using donated blood. The study was conducted at a hospital in Johannesburg, South Africa in 2002.
Results indicated no important differences between the two groups of participants with regard to survival, postoperative infection, or cost. There was a reduction in the amount of banked blood (blood that has been donated and stored) required for transfusion within the first 24 hours following injury among people receiving cell salvage. Data on other adverse events were not reported.
We believe that larger, multicentre, methodologically rigorous trials are needed to assess the relative efficacy, safety and cost-effectiveness of cell salvage in trauma surgery and other surgical procedures.
Quality of the evidence
The quality of the one study identified was high, but the number of participants was not large. No firm conclusions can be drawn as to the safety and effectiveness of cell salvage in individuals undergoing abdominal or thoracic trauma surgery.
Implications for practice
Evidence for the use of cell salvage in individuals undergoing abdominal and thoracic trauma surgery remains equivocal. The findings of a reduction in demand for donor blood transfusion with cell salvage compared with standard care after abdominal trauma surgery in the one study identified requires replication.
Implications for research
We identified only one study that met the inclusion criteria for this review. In the future, multicentre, methodologically rigorous trials are needed to assess the relative efficacy, safety and cost-effectiveness of cell salvage in different surgical procedures.Get full text at The Cochrane Library
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