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Meta-Analysis
. 2010 Apr 14;2010(4):CD001888.
doi: 10.1002/14651858.CD001888.pub4.

Cell salvage for minimising perioperative allogeneic blood transfusion

Paul A Carless  1 , David A Henry, Annette J Moxey, Dianne O'Connell, Tamara Brown, Dean A Fergusson
Affiliations
Meta-Analysis

Cell salvage for minimising perioperative allogeneic blood transfusion

Paul A Carless et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Concerns regarding the safety of transfused blood have prompted reconsideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements.

Objectives: To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes.

Search strategy: We identified studies by searching CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the internet (to August 2009) and bibliographies of published articles.

Selection criteria: Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to cell salvage (autotransfusion) or to a control group who did not receive the intervention.

Data collection and analysis: Data were independently extracted and the risk of bias assessed. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random-effects model. The primary outcomes were the number of patients exposed to allogeneic red cell transfusion and the amount of blood transfused. Other clinical outcomes are detailed in the review.

Main results: A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD -0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact adversely on clinical outcomes.

Authors' conclusions: The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: 1 Cell Salvage ‐ Blood Transfused (All Studies), outcome: 1.1 No. exposed to allogeneic blood (All Studies).
1.1
1.1. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 1 No. exposed to allogeneic blood (All Studies).
1.2
1.2. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 2 No. exposed to allogeneic blood (Transfusion Protocol).
1.3
1.3. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 3 No. exposed to allogeneic blood (Type of Surgery).
1.4
1.4. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 4 No. exposed to allogeneic blood ‐ (Washed vs Unwashed).
1.5
1.5. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 5 No. exposed to allogeneic blood (Timing).
1.6
1.6. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 6 Units of allogeneic blood transfused (All Studies).
1.7
1.7. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 7 Units of allogeneic blood transfused (Transfusion Protocol).
1.8
1.8. Analysis
Comparison 1 Cell salvage ‐ blood transfused (all studies), Outcome 8 Units of allogeneic blood transfused (Type of Surgery).
2.1
2.1. Analysis
Comparison 2 Cell salvage ‐ blood transfused (washed versus unwashed), Outcome 1 No. exposed to allogeneic blood (Cardiac).
2.2
2.2. Analysis
Comparison 2 Cell salvage ‐ blood transfused (washed versus unwashed), Outcome 2 No. exposed to allogeneic blood (Orthopaedic).
2.3
2.3. Analysis
Comparison 2 Cell salvage ‐ blood transfused (washed versus unwashed), Outcome 3 No. exposed to allogeneic blood (Vascular).
3.1
3.1. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 1 No. exposed to allogeneic blood (Active vs Control).
3.2
3.2. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 2 No. exposed to allogeneic blood (Transfusion Protocol).
3.3
3.3. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 3 No. exposed to allogeneic blood (Type of Surgery).
3.4
3.4. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 4 No. exposed to allogeneic blood (Washed vs Unwashed).
3.5
3.5. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 5 No. exposed to allogeneic blood (Timing).
3.6
3.6. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 6 Units of allogeneic blood transfused (Active vs Control).
3.7
3.7. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 7 Units of allogeneic blood transfused (Transfusion Protocol).
3.8
3.8. Analysis
Comparison 3 Cell salvage ‐ blood transfused (active versus control), Outcome 8 Units of allogeneic blood transfused (Type of Surgery).
4.1
4.1. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 1 No. exposed to allogeneic blood (Active vs Active).
4.2
4.2. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 2 No. exposed to allogeneic blood (Transfusion Protocol).
4.3
4.3. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 3 No. exposed to allogeneic blood (Type of Surgery).
4.4
4.4. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 4 No. exposed to allogeneic blood (Washed vs Unwashed).
4.5
4.5. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 5 No. exposed to allogeneic blood (Timing of cell salvage).
4.6
4.6. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 6 Units of allogeneic blood transfused (Active vs Active).
4.7
4.7. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 7 Units of allogeneic blood transfused (Transfusion Protocol).
4.8
4.8. Analysis
Comparison 4 Cell salvage ‐ blood transfused (active versus active), Outcome 8 Units allogeneic blood transfused (Type of Surgery).
5.1
5.1. Analysis
Comparison 5 Cell salvage ‐ blood loss, Outcome 1 Total blood loss (All Studies).
5.2
5.2. Analysis
Comparison 5 Cell salvage ‐ blood loss, Outcome 2 Total blood loss (Active vs Control).
5.3
5.3. Analysis
Comparison 5 Cell salvage ‐ blood loss, Outcome 3 Total blood loss (Active vs Active).
6.1
6.1. Analysis
Comparison 6 Cell salvage ‐ blood transfused (language and methodological quality), Outcome 1 Language of Publication (All Studies).
6.2
6.2. Analysis
Comparison 6 Cell salvage ‐ blood transfused (language and methodological quality), Outcome 2 Methodological Quality ‐ Allocation concealment (All Studies).
7.1
7.1. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 1 Mortality ‐ All Studies.
7.2
7.2. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 2 Mortality ‐ Active vs Control.
7.3
7.3. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 3 Mortality ‐ Active vs Active.
7.4
7.4. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 4 Re‐operation for bleeding ‐ All Studies.
7.5
7.5. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 5 Re‐operation for bleeding ‐ Active vs Control.
7.6
7.6. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 6 Re‐operation for bleeding ‐ Active vs Active.
7.7
7.7. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 7 Any infection ‐ All Studies.
7.8
7.8. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 8 Any infection ‐ Active vs Control.
7.9
7.9. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 9 Any Infection ‐ Active vs Active.
7.10
7.10. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 10 Wound complication ‐ All Studies.
7.11
7.11. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 11 Wound complication ‐ Active vs Control.
7.12
7.12. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 12 Wound complication ‐ Active vs Active.
7.13
7.13. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 13 Any thrombosis ‐ All Studies.
7.14
7.14. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 14 Any thrombosis ‐ Active vs Control.
7.15
7.15. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 15 Stroke ‐ All Studies.
7.16
7.16. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 16 Stroke ‐ Active vs Control.
7.17
7.17. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 17 Stroke ‐ Active vs Active.
7.18
7.18. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 18 Non‐fatal myocardial infarction ‐ All Studies.
7.19
7.19. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 19 Non‐fatal myocardial infarction ‐ Active vs Control.
7.20
7.20. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 20 Non‐fatal myocardial infarction ‐ Active vs Active.
7.21
7.21. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 21 Deep vein thrombosis (DVT).
7.22
7.22. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 22 Hospital length of stay (LOS) ‐ Active vs Control.
7.23
7.23. Analysis
Comparison 7 Adverse events and other outcomes, Outcome 23 Hospital length of stay (LOS) ‐ Active vs Active.
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References

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Tempe 2001 {published data only}
    1. Tempe DK, Banerjee A, Virmani S, Mehta N, Panwar S, Tomar AS, et al. Comparison of the effects of a cell saver and low dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery. Journal of Cardiothoracic and Vascular Anesthesia 2001;15(3):326‐30. - PubMed
Thomas 2001 {published data only}
    1. Thomas D, Wareham K, Cohen D, Hutchings H. Autologous blood transfusion in total knee replacement surgery. British Journal of Anaesthesia 2001;86(5):669‐73. - PubMed
Thurer 1979 {published data only}
    1. Thurer RL, Lytle BW, Cosgrove DM, Loop FD. Autotransfusion following cardiac operations: a randomized, prospective study. Annals of Thoracic Surgery 1979;27(6):500‐7. - PubMed
Tripkovic 2008 {published data only}
    1. Tripkovic B, Bukovic D, Sakic K, Sakic S, Bukovic N, Radakovic B. Quality of the blood sampled from surgical drainage after total hip arthroplasty. Collegium Antropologicum 2008;32(1):153‐60. - PubMed
Unsworth 1996 {published data only}
    1. Unsworth‐White MJ, Kallis P, Cowan D, Tooze JA, Bevan DH, Treasure T. A prospective randomised controlled trial of postoperative autotransfusion with and without a heparin‐bonded circuit. European Journal of Cardio‐thoracic Surgery 1996;10(1):38‐47. - PubMed
Ward 1993 {published data only}
    1. Ward HB, Smith RR, Landis KP, Nemzek TG, Dalmasso AP, Swaim WR. Prospective, randomized trial of autotransfusion after routine cardiac operations. Annals of Thoracic Surgery 1993;56(1):137‐41. - PubMed
Westerberg 2004 {published data only}
    1. Westerberg M, Bengtsson A, Jeppsson A. Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response. Annals of Thoracic Surgery 2004;78(1):54‐9. - PubMed
Wiefferink 2007 {published data only}
    1. Wiefferink A, Weerwind PW, Heerde W, Teerenstra S, Noyez L, Pauw BE, Brouwer R. Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements. Journal of Extra‐Corporeal Technology 2007;39(2):66‐70. - PMC - PubMed
Zacharopoulos 2007 {published data only}
    1. Zacharopoulos A, Apostolopoulos A, Kyriakidis A. The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study. International Orthopaedics 2007;31(3):303‐8. - PMC - PubMed
Zhang 2008 {published data only}
    1. Zhang XF, Dong JM, Gong ML, Shen SM, Zhou Y, Pan YF, Mao J. Effectiveness of preoperative autologous plateletpheresis combined with intraoperative autotransfusion on the blood coagulation in orthopaedic patients. [Chinese]. Chung‐Hua Wai Ko Tsa Chih [Chinese Journal of Surgery] 2008;46(2):118‐21. - PubMed
Zhao 1996 {published data only}
    1. Zhao K, Xiao M, Deng S. Autotransfusion of shed medistinal blood after open heart operation. Chinese Journal of Surgery 1996;34(8):497‐9. - PubMed
Zhao 2003 {published data only}
    1. Zhao K, Xu J, Hu S, Wu Q, Wei Y, Liu Y. Autotransfusion of shed mediastinal blood after open heart surgery. Chinese Medical Journal 2003;116:1179‐82. - PubMed

References to studies excluded from this review

Adan 1988 {published data only}
    1. Adan A, Brutel de la Riviere A, Haas F, Zalk A, Nooij E. Autotransfusion of drained mediastinal blood after cardiac surgery: a reappraisal. Thoracic and Cardiovascular Surgery 1988;36(1):10‐14. - PubMed
Bartels 1996 {published data only}
    1. Bartels C, Bechtel JV, Winkler C, Horsch S. Intraoperative autotransfusion in aortic surgery: comparison of whole blood autotransfusion versus cell separation. Journal of Vascular Surgery 1996;24(1):102‐8. - PubMed
Bell 1992 {published data only}
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Breakwell 2000 {published data only}
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Dalrymple‐Hay 2001 {published data only}
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Deramoudt 1991 {published data only}
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Elawad 1992 {published data only}
    1. Elawad AA, Ohlin AK, Berntorp E, Nilsson IM, Fredin H. Autologous blood transfusion in revision hip arthroplasty. A prospective, controlled study of 30 patients. Acta Orthopaedica Scandinavica 1992;63(4):373‐6. - PubMed
Farrer 1997 {published data only}
    1. Farrer A, Spark JI, Scott DJ. Autologous blood transfusion: the benefits to the patient undergoing abdominal aortic aneurysm repair. Journal of Vascular Nursing 1997;15(4):111‐5. - PubMed
Jacobi 1997 {published data only}
    1. Jacobi K, Walther A, Kuhn R, Dworak O, Neidhardt B, Rugheimer E. Advantages and limitations of intraoperative mechanical autotransfusion in radical prostatectomies. Anaesthetist 1997;46(2):101‐7. - PubMed
Kristensen 1992 {published data only}
    1. Kristensen PW, Sorensen LS, Thyregod HC. Autotransfusion of drainage blood in arthroplasty. A prospective, controlled study of 31 operations. Acta Orthopaedica Scandinavica 1992;63(4):377‐80. - PubMed
Mac 1993 {published data only}
    1. Mac HL, Reynolds MA, Treston‐Aurand J, Henke JA. Comparison of autoreinfusion and standard drainage systems in total joint arthroplasty patients. Orthopaedic Nursing 1993;12(3):19‐25. - PubMed
Mayer 1985 {published data only}
    1. Mayer ED, Welsch M, Tanzeem A, Saggau W, Spath J, Hummels R, Schmitz W. Reduction of postoperative donor blood requirement by use of the cell separator. Scandinavian Journal of Thoracic Cardiovascular Surgery 1985;19(2):165‐71. - PubMed
McShane 1987 {published data only}
    1. McShane AJ, Power C, Jackson JF, Murphy DF, MacDonald A, Moriarty DC, Otridge BW. Autotransfusion: quality of blood prepared with a red cell processing device. British Journal of Anaesthesia 1987;59(8):1035‐9. - PubMed
Schaff 1978b {published data only}
    1. Schaff HV, Hauer JM, Brawley RK. Autotransfusion in cardiac surgical patients after operation. Surgery 1978;84(5):713‐8. - PubMed
Schmidt 1997a {published data only}
    1. Schmidt H, Folsgaard S, Mortensen PE, Jensen E. Impact of autotransfusion after coronary artery bypass grafting on oxygen transport. Acta Anaesthesiologica Scandinavica 1997;41:995‐1001. - PubMed
    1. Schmidt H, Lund JO, Nielsen SL. Autotransfused shed mediastinal blood has normal erythrocyte survival. Annals of Thoracic Surgery 1996;62(1):105‐8. - PubMed
Schmidt 1997b {published data only}
    1. Schmidt H, Folsgaard S, Mortensen PE, Jensen E. Cardiac enzymes and autotransfusion of shed mediastinal blood after myocardial revascularization. Annals of Thoracic Surgery 1997;63:1288‐92. - PubMed
Skoura 1997 {published data only}
    1. Skoura H, Anastasiou E, Moshou A, Katsioulas A, Kostaki S. Value of autologous blood for intra‐operative massive bleeding. European Journal of Anaesthesiology 1997;14(1):103.
Thompson 1990 {published data only}
    1. Thompson JF, Webster JH, Chant AD. Prospective randomised evaluation of a new cell saving device in elective aortic reconstruction. European Journal of Vascular Surgery 1990;4(5):507‐12. - PubMed
Trubel 1995 {published data only}
    1. Trubel W, Gunen E, Wuppinger G, Tschernko E, Gunen‐Frank A, Staudacher M, et al. Recovery of intraoperatively shed blood in aortoiliac surgery: comparison of cell washing with simple filtration. The Thoracic and Cardiovascular Surgeon 1995;43(3):165‐70. - PubMed
Vertrees 1996 {published data only}
    1. Vertrees RA, Conti VR, Lick SD, Zwischenberger JB, McDaniel LB, Shulman G. Adverse effects of postoperative infusion of shed mediastinal blood. Annals of Thoracic Surgery 1996;62(3):717‐23. - PubMed

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