Background
Trauma is the leading cause of death in people under the age of 45 years. Over the past 20 years, transfusions using an individual's own blood, salvaged during surgery through a process called 'cell salvage' (also known as intraoperative blood salvage), have been used as an alternative to blood products donated from other individuals (standard care) during surgical procedures. Many people prefer this because of the risk of transfusion-related infections such as hepatitis and human immunodeficiency virus (HIV) from donor blood. In this review, we aimed to determine how effective cell salvage is, compared with usual care, in individuals undergoing abdominal or thoracic (chest) trauma surgery. We considered outcomes including the survival of the individual, their need for extra blood and the costs of this procedure compared with standard care.
Search date
Evidence in this review is current to 25 November 2014.
Study characteristics
We identified one randomised controlled trial, which involved people with a penetrating injury to the chest. In this study, 44 people (mostly male and with similar characteristics in terms of type of injury) were given either their own reprocessed blood (through cell salvage) or standard care using donated blood. The study was conducted at a hospital in Johannesburg, South Africa in 2002.
Results
Results indicated no important differences between the two groups of participants with regard to survival, postoperative infection, or cost. There was a reduction in the amount of banked blood (blood that has been donated and stored) required for transfusion within the first 24 hours following injury among people receiving cell salvage. Data on other adverse events were not reported.
We believe that larger, multicentre, methodologically rigorous trials are needed to assess the relative efficacy, safety and cost-effectiveness of cell salvage in trauma surgery and other surgical procedures.
Quality of the evidence
The quality of the one study identified was high, but the number of participants was not large. No firm conclusions can be drawn as to the safety and effectiveness of cell salvage in individuals undergoing abdominal or thoracic trauma surgery.
阅读完整摘要
Trauma is the leading cause of death in people under the age of 45 years. Over the past 20 years, intraoperative autologous transfusions (obtained by cell salvage, also known as intraoperative blood salvage (IBS)) have been used as an alternative to blood products from other individuals during surgery because of the risk of transfusion-related infections such as hepatitis and human immunodeficiency virus (HIV). In this review, we sought to assess the effects and cost of cell salvage in individuals undergoing abdominal or thoracic surgery.
研究目的
To compare the effect and cost of cell salvage with those of standard care in individuals undergoing abdominal or thoracic trauma surgery.
检索策略
We ran the search on 25 November 2014. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid OLDMEDLINE, EMBASE Classic + EMBASE (OvidSP), PubMed, and ISI Web of Science (SCI-Expanded & CPSI-SSH). We also screened reference lists and contacted principal investigators.
纳入排除标准
Randomised controlled trials comparing cell salvage with no cell salvage (standard care) in individuals undergoing abdominal or thoracic trauma surgery.
资料收集与分析
Two authors independently extracted data from the trial reports. We used the standard methodological procedures expected by The Cochrane Collaboration.
主要结果
Only one small study (n = 44) fulfilled the inclusion criteria. Results suggested that cell salvage did not affect mortality overall (death rates were 67% (14/21 participants) in the cell salvage group and 65% (15/23) in the control group) (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.31 to 3.72). For individuals with abdominal injury, mortality was also similar in both groups (OR 0.48, 95% CI 0.11 to 2.10).
Less donor blood was needed for transfusion within the first 24 hours postinjury in the cell salvage group compared with the control group (mean difference (MD) -4.70 units, 95% CI -8.09 to -1.31). Adverse events, notably postoperative sepsis, did not differ between groups (OR 0.54, 95% CI 0.11 to 2.55). Cost did not notably differ between groups (MD -177.81, 95% CI -452.85 to 97.23, measured in GBP in 2002).
作者结论
Evidence for the use of cell salvage in individuals undergoing abdominal or thoracic trauma surgery remains equivocal. Large, multicentre, methodologically rigorous trials are needed to assess the relative efficacy, safety and cost-effectiveness of cell salvage in different surgical procedures in the emergency context.
