Cell salvage in burn excisional surgery

Gigengack, Rolf K.; Gemert, A.W.M.M. Koopman-van; Oen, I.M.M.H.; Ossewaarde, Tjaco M van; Koopman, Seppe; Loer, Stephan A.; Vlies, Cornelis H. van der

doi:10.1016/j.burns.2020.06.030

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Whether the bacterial load can be eliminated by washing techniques [85,86] has been debated, as blood contamination with penetrating trauma or enteral injury can lead to disseminated infection. One option to counteract this risk may be the administration of antibiotics at the time of re-transfusion of autologous blood [87].…”

Section: Weak Evidence Of Cell Salvage In Civilian Trauma Bleedingmentioning

confidence: 99%

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

2022

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Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient selection criteria are needed. The main concerns in the case of oncological surgery are the reinfusion of tumour cells, thereby increasing the risk of metastasis. This threat could be minimized, which may help to rationalize its indication. In severe peripartum haemorrhage, cell salvage has not proven cost-effective, damage control techniques have been developed, and, given the risk of fetomaternal alloimmunization and amniotic fluid embolism, it is increasingly out of use. In trauma, bleeding may originate from multiple sites, coagulopathy may develop, and it should be evaluated whether re-transfusion of autologous blood collected from uncontaminated organ cavities would be feasible. General safety measures include washing recovered blood and its passage through leukocyte depletion filters. To date, no well-defined indications for cell salvage have been established for these pathologies, but with accurate case selection and selective implementation, it could become safe and effective. Randomized clinical trials are urgently needed.

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Section: Weak Evidence Of Cell Salvage In Civilian Trauma Bleedingmentioning

confidence: 99%

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

2022

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Management strategies for perioperative anaemia in the severely burn-injured Jehovah’s Witness patients who decline a blood transfusion: A systematic review with illustrative case reports

Jung

Harish²,

Wijewardena³

et al. 2023

Burns

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Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

Slob,

Gigengack,

van Baar

et al. 2024

BMC Anesthesiol

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Summary Background Reducing blood loss during excisional surgery in burn patients remains a challenge. Tranexamic acid during surgery can potentially reduce blood loss. The use of tranexamic acid during excisional surgery in burn patients has recently been described in a review and meta-analysis. However, quality assessment on studies included was not performed and this review did not apply independent reviewers. Quality assessment of studies investigating the effectiveness of tranexamic acid in burn patients is crucial before concusions can be drawn. Therefore, we conducted a systematic review and meta-analysis of the literature investigating the effectiveness of tranexamic acid in burn patients undergoing surgery. Methods A systematic review and meta-analysis of the literature was conducted. The study was pre-registered in PROSPERO database (CRD42023396183). Results Five studies including two randomised controlled trials (RCTs) with a total of 303 patients were included. Risk of bias of the included studies was moderate to high. Individual results of the studies were heterogeneous. In three studies of moderate quality the administration of tranexamic acid resulted in a reduction of blood loss per unit excised area, accounting as moderate level of evidence. In two low-quality studies and one moderate quality study the administration of tranexamic acid resulted in a reduction of transfused packed Red Blood Cells (pRBC’s), accounting for moderate level of evidence. Postoperative haemoglobin levels were higher after tranexamic acid administration in one study, accounting for insufficient evidence. Meta-analysis pooling overall blood loss from two separate RCTs failed to detect a statistically significant reduction. Substantial heterogeneity was observed. Conclusions Moderate level of evidence indicates that tranexamic acid reduces blood loss per unit of excised area and transfusion of packed Red Blood Cells. Results indicate that tranexamic acid can be beneficial in burn patients undergoing surgery. More high-quality research is needed to confirm these results. Future studies should focus on the dosing of tranexamic acid, the administration approaches, and even consider combining these approaches. Trial Registration PROSPERO: CRD42023396183

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Cell salvage in burn excisional surgery

Cited by 3 publications

References 23 publications

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

Management strategies for perioperative anaemia in the severely burn-injured Jehovah’s Witness patients who decline a blood transfusion: A systematic review with illustrative case reports

Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

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