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Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review

[La récupération de sang ne réduit pas la nécessité d’une transfusion allogénique périopératoire en chirurgie vasculaire abdominale : une revue systématique]

From the University of Ottawa, Centre for Transfusion Research, Ottawa, Ontario, Canada.

Address correspondence to: Dr. Paul C. Hébert, Centre for Transfusion and Clinical Epidemiology Program, Ottawa Health Research Institute, General Campus, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6, Canada. Phone: 613-737-8197; Fax 613-739-6266; E-mail: phebert{at}ohri.ca

Purpose: To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery.

Source: We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001. The search included textword searches using "autotransfusion," "cell salvage," "device," or Medical Subject Headings "autologous blood transfusion" or a "randomized controlled trials" filter.

Principal findings: Five randomized controlled trials (RCT) were identified involving cell salvage and vascular surgeries. In infra renal abdominal aortic aneurysm surgery the risk ratio (the risk of receiving at least one unit of allogeneic red cells) was 0.37 [95% confidence intervals (CI) of 0.06 to 2.36]. In elective aorto-femoral bypass surgery the risk ratio was 0.97 (95% CI of 0.66 to 1.42). The pooled risk ratio for cell salvage in vascular surgery was 0.67 (95% CI of 0.35 to 1.28).

Conclusion: Cell salvage, a commonly used technique to recover red cells from the operative field, has been the subject of several studies in vascular surgery. There is insufficient evidence to recommend the routine use of cell salvage in elective abdominal aortic aneurysm and aorto-femoral bypass surgeries. A large RCT would elucidate whether cell salvage is effective as a blood conservation technique.

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