Autotransfusion in trauma. A pragmatic analysis

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Transfusion Medicine

Background:

• The role of autotransfusion in managing trauma patients remains unclear.
• Pragmatic factors influencing the effectiveness of autotransfusion in trauma require identification.

Purpose of the Study:

• To identify practical limitations hindering the utility of autotransfusion in trauma victims.
• To assess the actual use and effectiveness of the Cell Saver III device in a trauma setting.

Main Methods:

• A review of 85 trauma victims where the Cell Saver III autotransfusion device was prepared for use.
• Analysis of reasons for non-utilization of the autotransfuser and the volume of autologous blood transfused when used.

Main Results:

• Only 22 (26%) of trauma patients received autologous blood.
• Primary reasons for non-utilization included inadequate blood retrieval (60%), colon injury contamination (21%), and operating room death (19%).
• Patients receiving autologous blood had significant blood loss (avg. 8,600 ml), with autotransfuser contributing only 28% (2,250 ml) of total transfused blood.

Conclusions:

• Inadequate blood scavenging is the primary obstacle to effective autotransfusion in trauma.
• An initial hematocrit <35% and >2L crystalloid resuscitation may indicate potential benefit from autotransfusion.
• Patient factors like age, injury mechanism, and shock presence did not predict autotransfusion usefulness.