Is the "salvaged-cell syndrome" myth or reality?

Area of Science:

• Medical Science
• Surgical Innovation
• Critical Care Medicine

Background:

• Intraoperative autotransfusion (IAT) is suspected to cause coagulopathy.
• This study investigates the link between IAT and coagulopathy, including disseminated intravascular coagulation (DIC).

Purpose of the Study:

• To assess the hypothesis that intraoperative autotransfusion precipitates or aggravates coagulopathy.
• To determine the incidence of coagulopathy (DIC) and adult respiratory distress syndrome (ARDS) in patients undergoing IAT.

Main Methods:

• Retrospective database review of over 36,000 multispecialty cases of IAT.
• Analysis focused on the occurrence of DIC and ARDS in association with IAT over an 18-year period.

Main Results:

• The incidence of coagulopathy was low at 0.05%.
• 18 cases of DIC/ARDS were identified, primarily in patients with ruptured aneurysms, massive trauma, or complex cardiac surgery, all experiencing shock, hypothermia, and requiring extensive transfusions (mean 28 units).
• Mortality in these 18 cases was 100%.

Conclusions:

• Coagulopathy following IAT is infrequent.
• Shock, hypothermia, and massive transfusions are the likely triggers for DIC and ARDS, rather than the autotransfusion process itself.
• ARDS may result from reperfusion injury after ischemic events, often linked to multiorgan failure.