Anesthetic Techniques: Autotransfusion

Summary [In this prospective study the authors evaluate the cost-effectiveness of routine use of intraoperative blood salvage (IBS) in adult liver transplantation. It is helpful in view of previous studies concluding that routine IBS is not cost-effective in liver transplantation or that it is only cost-effective when transfusion requirements are considerable. The authors also highlight its importance given the reported 340% increase in the cost of allogeneic blood products in the United Kingdom over the period of their study, and ongoing safety concerns with donor blood.

Although potentially life-saving in hemorrhaging trauma patients, autologous salvage of enteric-contaminated blood for reinfusion has been considered contraindicated. With considerable literature support for its use and ethics committee approval, Bowley and colleagues from Johannesburg, Republic of South Africa, conducted a prospective randomized controlled trial investigating intraoperative blood salvage (IBS) as a means of reducing allogeneic blood transfusion in penetrating abdominal trauma.

Summary This prospective randomized trial by the cardiothoracic surgery team at St George’s Hospital in the United Kingdom evaluated the use of autologous intraoperative cell salvage (ICS) in both on- and off-pump (on- and off-cardiopulmonary bypass) coronary artery bypass graft (CABG) surgery patients. The trial was designed to evaluate the effects of ICS on blood loss, allogeneic blood transfusion and clotting parameters in patients undergoing first time isolated CABG surgery.

Summary This interesting pilot study sought to address the question of whether post-surgery anemia decreases exercise performance in patients undergoing total hip arthroplasty and shed light on how lower postoperative hemoglobin levels may affect patients’ ability to participate in rehabilitation programs. Performance was evaluated using a bicycle ergometer exercise test with cardiovascular fitness as the primary outcome. In an experimental group, the investigators used autologous blood collected preoperatively to return postoperative hemoglobin (Hb) levels to pre-surgery admission values.

Summary Moskowitz and colleagues from the Englewood Hospital and Medical Center in New Jersey USA present this case report describing the use of the Hemobag® in a 67-year-old Jehovah’s Witness patient undergoing 4-vessel coronary artery bypass graft surgery on cardiopulmonary bypass (CPB). Preoperatively the patient was optimized with erythropoietin and iron, according to their institution’s protocol, to a target hematocrit (Hct) of 45%. Intraoperatively 2350 mL of autologous blood was collected (intraoperative autologous donation - IAD).

Summary To the authors’ knowledge this is the first study to evaluate intraoperative cell salvage (ICS) in revision hip replacement surgery using individually matched patients as a control group. Forty-seven patients undergoing revision hip surgery in whom ICS had been used made up the study group. Forty-seven patients who had undergone revision hip replacement surgery prior to ICS being introduced served as a historical control group.

Summary This invitro model study by Waters and colleagues suggests that combing acute normovolemic hemodilution (ANH) with intraoperative cell salvage may reduce red blood cell damage due to mechanical injury and improve red cell recovery. Air aspirated along with blood from the surgical field during cell salvage results in red cell injury and hemolysis due to turbulence and shear stress. To reduce this damage and improve the recovery rate, many cell salvage operators minimize the suction pressure.

Summary In this randomized controlled trial Licker and coworkers investigated whether, in addition to standard protection techniques, moderate acute normovolemic hemodilution (ANH) provides protection to the heart from ischemic and reperfusion injury in patients undergoing open heart surgery. Forty patients with severe aortic valve stenosis associated with left ventricular hypertrophy and without other significant comorbidities scheduled for valve replacement surgery were randomly assigned to one of two groups, an ANH group (n=19) and a control group (n=21).

Summary One hundred and sixty joint (hip and knee) replacement surgery patients were enrolled in this randomized controlled trial to evaluate the efficacy and safety of filtered postoperative drain blood reinfusion. Outcome measures were allogeneic blood transfusion rates and postoperative complications, specifically febrile reactions. Consecutive patients scheduled for elective primary total knee replacement (TKR) and total hip replacement (THR) at a single institution were randomly assigned to either a study group or a control group.

Summary This prospective non-randomized study compared two consecutive series of patients undergoing total hip replacement (THR) surgery in order to examine the effect of postoperative drain blood reinfusion on transfusion requirements and hospital length of stay. Although previous studies have demonstrated reduced allogeneic transfusion with postoperative autologous blood salvage in total knee replacement surgery, similar benefits have not been well demonstrated in THR surgery. The study by Sturdee and colleagues comprised a total of 86 patients.