Autologous blood transfusion during emergency trauma operations

Hypothesis: Intraoperative cell salvage (CS) of shed blood during emergency surgical procedures provides an effective and cost-efficient resuscitation alternative to allogeneic blood transfusion, which is associated with increased morbidity and mortality in trauma patients. Design: Retrospective matched cohort study. Setting: Level I trauma center. Patients: All adult trauma patients who underwent an emergency operation and received CS as part of their intraoperative resuscitation. The CS group was matched to a no-CS group for age, sex, Injury Severity Score, mechanism of injury, and operation performed. Main Outcome Measures: Amount and cost of allogeneic transfusion of packed red blood cells and plasma. Results: The 47 patients in the CS group were similar to the 47 in the no-CS group for all matched variables. Patients in the CS group received an average of 819 mL of autologous CS blood. The CS group received fewer intraoperative (2 vs 4 U; P=.002) and total (4 vs 8 U; P<.001) units of allogeneic packed red blood cells. The CS group also received fewer total units of plasma (3 vs 5 U; P=.03). The cost of blood product transfusion (including the total cost of CS) was less in the CS group ($1616 vs $2584 per patient; P=.004). Conclusion: Intraoperative CS provides an effective and cost-efficient resuscitation strategy as an alternative to allogeneic blood transfusion in trauma patients undergoing emergency operative procedures.