3.6 Effect of perioperative strategies that minimise blood loss
3.6.7 Perioperative acute normovolemic haemodilution combined with intraoperative cell salvage
The detailed findings of the systematic review for this intervention can be found in Section 3.3.1 of Volume 1b of the technical report.4 The systematic review identified two fair-quality Level II studies (RCTs) examining the effect of combined perioperative ANH and intraoperative cell salvage.204,205
Transfusion requirements
One study observed a significant reduction in both the incidence and volume of allogeneic blood transfusion.204 The other study found a significant reduction in volume of allogeneic blood transfused compared with the control, but no effect on incidence.205 However, neither study demonstrated an additive effect of the combined interventions.
| EVIDENCE STATEMENTS – perioperative acute normovolemic haemodilution combined with intraoperative cell salvage | Evidence | Consistency | Clinical impact | Generalisability | Applicability |
|---|---|---|---|---|---|
| In adult patients undergoing surgery in which substantial blood loss is anticipated, a combination of ANH and intraoperative cell salvage may reduce the incidence of allogeneic blood transfusion. | |||||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, a combination of ANH and intraoperative cell salvage may reduce the volume of allogeneic blood transfusion. | |||||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on blood loss is uncertain. | NA | X | |||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of perioperative ANH and intraoperative cell salvage on mortality is uncertain. | NA | X | |||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of perioperative ANH and intraoperative cell salvage on morbidity is uncertain. | X | ||||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on quality of life is unknown. | NA | NA | NA | NA | NA |
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on risk of reoperation for bleeding is uncertain. | NA | X | |||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on risk of reoperation for bleeding is uncertain. | NA | X | |||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on hospital length of stay is uncertain. | X | ||||
| In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of a combination of ANH and intraoperative cell salvage on ICU length of stay is uncertain. | X |
ANH, acute normovolemic haemodilution
(See Table 2.2)