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Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic
Gonzalo G Alvarez1, Dean A Fergusson, David T Neilipovitz
1University of Ottawa, Centre for Transfusion Research, Ottawa, Ontario, Canada.
Insights
Cell salvage may reduce allogeneic red blood cell transfusions in vascular surgery, but current evidence is insufficient for routine use in abdominal aortic aneurysm and aorto-femoral bypass procedures. Further large randomized controlled trials are needed.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Cell salvage is a technique used to recover and reinfuse a patient's own red blood cells lost during surgery.
- Its effectiveness in reducing allogeneic blood transfusions in elective vascular surgery remains under investigation.
Purpose of the Study:
- To evaluate the efficacy of cell salvage in decreasing the need for allogeneic packed red blood cell transfusions during perioperative periods of elective vascular surgery.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted using MEDLINE, EMBASE, and the Cochrane library.
- Searches included terms related to cell salvage, autotransfusion, and randomized controlled trials, covering literature from 1966 to April 2001.
Main Results:
- Five RCTs involving cell salvage in vascular surgery were identified.
- In infrarenal abdominal aortic aneurysm surgery, the risk ratio for receiving allogeneic red cells was 0.37 (95% CI, 0.06-2.36).
- For elective aorto-femoral bypass surgery, the risk ratio was 0.97 (95% CI, 0.66-1.42), with a pooled risk ratio for cell salvage in vascular surgery of 0.67 (95% CI, 0.35-1.28).
Conclusions:
- Current evidence is insufficient to recommend routine cell salvage for elective abdominal aortic aneurysm and aorto-femoral bypass surgeries.
- Cell salvage's role as a blood conservation technique in vascular surgery requires further investigation through large-scale RCTs.
Purpose:
To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery.
Source:
We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001. The search included textword searches using "autotransfusion," "cell salvage," "device," or Medical Subject Headings "autologous blood transfusion" or a "randomized controlled trials" filter.
Principal Findings:
Five randomized controlled trials (RCT) were identified involving cell salvage and vascular surgeries. In infra renal abdominal aortic aneurysm surgery the risk ratio (the risk of receiving at least one unit of allogeneic red cells) was 0.37 [95% confidence intervals (CI) of 0.06 to 2.36]. In elective aorto-femoral bypass surgery the risk ratio was 0.97 (95% CI of 0.66 to 1.42). The pooled risk ratio for cell salvage in vascular surgery was 0.67 (95% CI of 0.35 to 1.28).
Conclusion:
Cell salvage, a commonly used technique to recover red cells from the operative field, has been the subject of several studies in vascular surgery. There is insufficient evidence to recommend the routine use of cell salvage in elective abdominal aortic aneurysm and aorto-femoral bypass surgeries. A large RCT would elucidate whether cell salvage is effective as a blood conservation technique.
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