Utilization of blood recycling in nonelective surgery

Intraoperative infusion of autologous shed blood is efficacious in elective vascular, cardiac, and orthopedic surgery. Blood recycling has also been advocated for emergency and trauma surgery. We examined 33 candidates for autotransfusion during emergency surgery. Autologous blood accounted for only 11% of the total blood replaced. Only 25 of the patients survived long enough to permit reinfusion. Because of rapid hemostasis, nine of the remaining patients (36%) received less than the 2 units necessary to be cost-effective. No evidence was found for septicemia or coagulopathy caused by autotransfusion. We concluded that, as currently applied, recycling of shed blood during emergency surgery is of value in a limited group of patients. The collection and storage of heparinized shed blood during the preoperative and early intraoperative periods, with later processing and reinfusion in selected patients, may expand its applicability.