Should the Cell Saver Autotransfusion Device* be used routinely in all infrarenal abdominal aortic bypass operations?

Abstract

We conclude that routine setup and use of rapid autotransfusion devices may not be necessary in every patient undergoing routine aortofemoral bypass for occlusive disease. Furthermore, the possibility that some patients may undergo AAA repair with tube grafts without use of the Cell Saver may be deserving of further investigation.

Cell Salvage – State of the Art and Cost‐Effectiveness

“…In vascular surgery, data on the efficacy of ICS have been contradictory. Although there have been many retrospective [29][30][31][32][33][34] and prospective 18,[35][36][37][38] studies investigating the role of cell salvage in aortic surgery, until recently, only three prospective randomized controlled trials had been reported. [39][40][41] In the largest of the three, Clagett et al 41 randomized 100 patients undergoing infrarenal aortic reconstruction to ICS or standard transfusion practice with allogeneic blood when needed.…”

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

“…8,12 Neither study demonstrated a clinically important decrease in the number of patients exposed to red cells following the use of cell salvage. The Clagett study reported a RR of 0.94 (95% CI from 0.63 to 1.40) and the Kelley-Patteson study reported a RR of 1.50 (95% CI from 0.28 to 7.93).…”

“…8,12 This surgical intervention requires significantly less RBC transfusions as compared to aortic aneurysm surgery. Both major studies 8,12 evaluating cell salvage during aortofemoral bypass were not able to document any savings in allogeneic RBC use with this technique. Inferences from these studies and the resultant meta-analysis are weak given the small sample size of both individual studies and the pooled results.…”

“…11,14 The three remaining trials, made use of sealed opaque envelopes as a means of concealment of randomization. 8,12,13 None of these studies made use of blinding. It would have been technically difficult if not impossible to mask cell salvage from the anesthesiologist and surgeon.…”

“…Five randomized controlled trials compared cell salvage to control in abdominal vascular surgical procedures. 8,[11][12][13][14] Two additional trials were excluded because allocation did not make use of randomization but rather alternately assigned patients to either cell salvage or no cell salvage. 11,14 The three remaining trials, made use of sealed opaque envelopes as a means of concealment of randomization.…”