Autotransfusion in trauma. A pragmatic analysis

The precise role of autotransfusion in trauma is ill defined. This review was undertaken to identify pragmatic factors that limit the utility of autotransfusion in trauma. The Cell Saver III autotransfusion devise was prepared for use in 85 trauma victims. Only 22 (26 percent) of these patients actually received autologous blood. The remaining 63 patients (74 percent) did not utilize the autotransfuser because of inadequate blood retrieved (60 percent), extensive contamination from colon injury (21 percent), or operating room death before reinfusion (19 percent). Those receiving autologous blood had an average 8,600 ml blood loss, but only 2,250 ml or 28 percent of the total blood transfused was from the autotransfuser. Age, mechanism of injury, and presence of shock were not predictors of autotransfusion usefulness. An initial hematocrit value of less than 35 percent and more than 2 liters of crystalloid resuscitation in the emergency department indicate a potential role for autotransfusion. Inadequate blood scavenging remains the principal limiting factor in autotransfusion for trauma.