Patient Blood Management Guidelines: Module 2

Perioperative

3.6 Effect of perioperative strategies that minimise blood loss

3.6.6 Intraoperative cell salvage

The detailed findings of the systematic review for this intervention can be found in Section 3.2.1 of Volume 1b of the technical report.4 The systematic review process identified five Level I studies174,191-194 and nine Level II studies195–203 (RCTs), of fair to good quality.

Transfusion requirements

Meta-analyses found that, overall, the incidence and volume of allogeneic blood transfused were significantly lower for the individuals who received intraoperative cell salvage.

EVIDENCE STATEMENTS – for intraoperative cell salvage Evidence Consistency Clinical impact Generalisability Applicability
In adult patients undergoing surgery in which substantial blood loss is anticipated, intraoperative cell salvage reduces the incidence of allogeneic blood transfusion.
In adult patients undergoing surgery in which substantial blood loss is anticipated, intraoperative cell salvage may reduce the volume of allogeneic blood transfused.
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on operative blood loss is uncertain. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on mortality is uncertain. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on morbidity is uncertain.
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on quality of life is unknown. NA NA NA NA NA
In adult patients undergoing off-pump coronary artery surgery, intraoperative cell salvage may increase postoperative haemoglobin concentration and haematocrit. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on risk of reoperation for bleeding is uncertain. X
In adult patients undergoing off-pump coronary artery surgery, the effect of intraoperative cell salvage on coagulation status is uncertain. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of intraoperative cell salvage on length of hospital stay is uncertain. X
In adult patients undergoing cardiac surgery, the effect of intraoperative cell salvage on intensive care unit admission and length of stay is uncertain. X

RBC, red blood cell

3 ticks = A; 2 ticks B; 1 tick = C; X = D; NA = not applicable (See Table 2.2)

RECOMMENDATION – intraoperative cell salvage

R15

Grade C
In adult patients undergoing surgery in which substantial blood loss (blood loss of a volume great enough to induce anaemia that would require therapy) is anticipated,intraoperative cell salvage is recommended (Grade C).

PRACTICE POINT – intraoperative cell salvage

PP13

Intraoperative cell salvage requires a local procedural guideline that should include patient selection, use of equipment and reinfusion. All staff operating cell salvage devices should receive appropriate training, to ensure knowledge of the technique and proficiency in using it.