title: Cell salvage for minimising perioperative allogeneic blood transfusion.
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.
  
  
  OBJECTIVE
  To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Discipline of Clinical Pharmacology, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street, Waratah, Newcastle, New South Wales, Australia, 2298.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carless
authors.forename: David A
authors.initials: DA
authors.lastname: Henry
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Moxey
authors.forename: Dianne
authors.initials: D
authors.lastname: O'Connell
authors.forename: Tamara
authors.initials: T
authors.lastname: Brown
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
mesh_terms: D000328:Adult; D001800:Blood Specimen Collection / Q000379:methods; D001804:Blood Transfusion, Autologous; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion; D006801:Humans; D016032:Randomized Controlled Trials as Topic
references.citation: J Vasc Surg. 1997 Jun;25(6):984-93; discussion 993-4
references.pmid: 9201158
references.citation: J Arthroplasty. 1995 Aug;10(4):532-9
references.pmid: 8523015
references.citation: Scand J Thorac Cardiovasc Surg. 1989;23(1):47-9
references.pmid: 2727646
references.citation: Vox Sang. 1997;72(2):85-92
references.pmid: 9088075
references.citation: AIDS. 1998;12 Suppl A:S81-6
references.pmid: 9632988
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: Transfusion. 2007 Mar;47(3):379-84
references.pmid: 17319816
references.citation: Med J Aust. 1997 Jun 2;166(11):584-6
references.pmid: 9201178
references.citation: Ann Thorac Surg. 1979 Jun;27(6):500-7
references.pmid: 454027
references.citation: Eur J Cardiothorac Surg. 1993;7(9):474-7
references.pmid: 7692899
references.citation: Surgery. 1978 Nov;84(5):713-8
references.pmid: 715689
references.citation: Scand Cardiovasc J. 2006 Jun;40(3):194-8
references.pmid: 16798668
references.citation: Scand J Thorac Cardiovasc Surg. 1985;19(2):165-71
references.pmid: 4048888
references.citation: Acta Orthop Belg. 2006 Jan;72(1):15-7
references.pmid: 16570888
references.citation: Anesth Analg. 1999 Oct;89(4):861-9
references.pmid: 10512256
references.citation: J Vasc Surg. 1999 Jan;29(1):22-30; discussion 30-1
references.pmid: 9882786
references.citation: Ann Thorac Surg. 1999 Sep;68(3):940-5
references.pmid: 10509988
references.citation: JAMA. 2000 Jul 12;284(2):229-35
references.pmid: 10889598
references.citation: Ann Thorac Surg. 2004 Jul;78(1):54-9
references.pmid: 15223402
references.citation: Annu Rev Public Health. 1995;16:253-82
references.pmid: 7639874
references.citation: Int Orthop. 2007 Dec;31(6):837-44
references.pmid: 17115155
references.citation: Eur J Cardiothorac Surg. 1990;4(11):595-600
references.pmid: 2268438
references.citation: Eur J Cardiothorac Surg. 2006 Aug;30(2):271-7
references.pmid: 16829083
references.citation: Ann Thorac Surg. 1997 May;63(5):1288-92
references.pmid: 9146316
references.citation: Transfus Med. 1999 Mar;9(1):21-30
references.pmid: 10216902
references.citation: Int Orthop. 2007 Apr;31(2):235-9
references.pmid: 16761149
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001886
references.pmid: 17943760
references.citation: Thorac Cardiovasc Surg. 1995 Jun;43(3):165-70
references.pmid: 7570569
references.citation: Transfus Med Rev. 1998 Jul;12(3):206-25
references.pmid: 9673005
references.citation: Arch Intern Med. 1998 Mar 23;158(6):610-6
references.pmid: 9521225
references.citation: Zhonghua Wai Ke Za Zhi. 1996 Aug;34(8):497-9
references.pmid: 9594199
references.citation: Med J Aust. 2000 Sep;173(5):266-8
references.pmid: 11144331
references.citation: Transfus Med. 1997 Dec;7(4):277-80
references.pmid: 9510924
references.citation: Transfus Med. 2007 Aug;17(4):285-9
references.pmid: 17680954
references.citation: Ann Thorac Surg. 1989 Oct;48(4):514-7
references.pmid: 2802852
references.citation: N Engl J Med. 1990 Jun 7;322(23):1646-51
references.pmid: 2342524
references.citation: J Arthroplasty. 1993 Oct;8(5):523-7
references.pmid: 8245998
references.citation: Anaesthesist. 1991 Apr;40(4):205-13
references.pmid: 2058822
references.citation: Acta Orthop Belg. 2006 Jan;72(1):18-23
references.pmid: 16570889
references.citation: Eur J Vasc Endovasc Surg. 1997 Dec;14(6):482-6
references.pmid: 9467524
references.citation: J Vasc Nurs. 1997 Dec;15(4):111-5
references.pmid: 9429379
references.citation: J Thorac Cardiovasc Surg. 1978 Apr;75(4):632-41
references.pmid: 642556
references.citation: J Thorac Cardiovasc Surg. 1989 Feb;97(2):213-9
references.pmid: 2783753
references.citation: J Bone Joint Surg Br. 1997 Jul;79(4):630-2
references.pmid: 9250753
references.citation: Acta Orthop Scand. 1992 Aug;63(4):373-6
references.pmid: 1529682
references.citation: Anaesthesist. 1997 Feb;46(2):101-7
references.pmid: 9133170
references.citation: Acta Orthop Scand. 1998 Oct;69(5):475-8
references.pmid: 9855227
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: Lancet. 2000 Sep 16;356(9234):955-6
references.pmid: 11041390
references.citation: J Thorac Cardiovasc Surg. 2000 Sep;120(3):499-504
references.pmid: 10962411
references.citation: Ann Thorac Surg. 1996 Sep;62(3):717-23
references.pmid: 8783998
references.citation: Br J Clin Pract. 1991 Summer;45(2):105-8
references.pmid: 1793694
references.citation: Orthopedics. 1994 Feb;17(2):133-7
references.pmid: 8190677
references.citation: Thorac Cardiovasc Surg. 1988 Feb;36(1):10-4
references.pmid: 3259732
references.citation: Chin Med J (Engl). 2003 Aug;116(8):1179-82
references.pmid: 12935406
references.citation: Eur J Cardiothorac Surg. 1996;10(1):38-47
references.pmid: 8776184
references.citation: Acta Orthop Scand. 1992 Aug;63(4):377-80
references.pmid: 1529683
references.citation: J Bone Joint Surg Am. 1994 Jan;76(1):35-8
references.pmid: 8288663
references.citation: Transfus Med Rev. 1999 Apr;13(2):106-17
references.pmid: 10218234
references.citation: J Card Surg. 1994 May;9(3):314-21
references.pmid: 8054726
references.citation: Eur J Vasc Surg. 1990 Oct;4(5):507-12
references.pmid: 2226884
references.citation: Br J Anaesth. 1987 Aug;59(8):1035-9
references.pmid: 3651272
references.citation: Knee. 2002 May;9(2):145-8
references.pmid: 11950579
references.citation: Transfusion. 1993 Feb;33(2):139-44
references.pmid: 8430453
references.citation: N Engl J Med. 2008 May 29;358(22):2319-31
references.pmid: 18480196
references.citation: Chest. 1993 Sep;104(3):686-9
references.pmid: 8365276
references.citation: Orthop Nurs. 1993 May-Jun;12(3):19-25
references.pmid: 8321561
references.citation: Knee. 2000 Jul 1;7(3):145-147
references.pmid: 10927206
references.citation: J Bone Joint Surg Am. 1995 Sep;77(9):1347-51
references.pmid: 7673284
references.citation: Transfus Med Rev. 2002 Jul;16(3):187-99
references.pmid: 12075558
references.citation: Lancet. 2000 Sep 16;356(9234):999-1000
references.pmid: 11041403
references.citation: Zhonghua Wai Ke Za Zhi. 2008 Jan 15;46(2):118-21
references.pmid: 18509970
references.citation: J Cardiothorac Vasc Anesth. 1991 Oct;5(5):454-6
references.pmid: 1932650
references.citation: J Extra Corpor Technol. 2007 Jun;39(2):66-70
references.pmid: 17672185
references.citation: Anesth Analg. 1997 Dec;85(6):1258-67
references.pmid: 9390590
references.citation: Int Orthop. 2007 Jun;31(3):303-8
references.pmid: 16810542
references.citation: Acta Biomed Ateneo Parmense. 1995;66(5):195-201
references.pmid: 8928582
references.citation: Anaesthesist. 1992 Jan;41(1):27-33
references.pmid: 1536438
references.citation: Transfusion. 1992 Nov-Dec;32(9):873-4
references.pmid: 1471253
references.citation: J Arthroplasty. 1991 Jun;6(2):109-14
references.pmid: 1875200
references.citation: Cochrane Database Syst Rev. 2002;(2):CD002042
references.pmid: 12076437
references.citation: Eur J Cardiothorac Surg. 1999 Jun;15(6):830-4
references.pmid: 10431866
references.citation: Ann Thorac Surg. 1994 Mar;57(3):615-22
references.pmid: 8147630
references.citation: Anaesth Intensive Care. 1987 Aug;15(3):282-8
references.pmid: 3661961
references.citation: Transfusion. 1998 Jun;38(6):522-9
references.pmid: 9661685
references.citation: J Bone Joint Surg Br. 1991 Jul;73(4):591-4
references.pmid: 1906472
references.citation: Br J Anaesth. 2001 May;86(5):669-73
references.pmid: 11575343
references.citation: Transfus Med. 1992 Dec;2(4):295-300
references.pmid: 1285042
references.citation: Transfusion. 1991 May;31(4):355-60
references.pmid: 1902337
references.citation: Acta Anaesthesiol Scand. 1995 Apr;39(3):390-5
references.pmid: 7793222
references.citation: J Thorac Cardiovasc Surg. 2005 Jul;130(1):20-8
references.pmid: 15999036
references.citation: Clin Orthop Relat Res. 1994 Feb;(299):53-9
references.pmid: 8119037
references.citation: Anesth Analg. 1998 Jan;86(1):9-15
references.pmid: 9428843
references.citation: J Bone Joint Surg Br. 2008 Apr;90(4):451-4
references.pmid: 18378918
references.citation: Cardiovasc Surg. 2001 Apr;9(2):184-7
references.pmid: 11250189
references.citation: Int J Technol Assess Health Care. 1999 Fall;15(4):717-28
references.pmid: 10645113
references.citation: J Bone Joint Surg Br. 2007 Aug;89(8):1092-7
references.pmid: 17785752
references.citation: J Cardiothorac Vasc Anesth. 1996 Jun;10(4):502-6
references.pmid: 8776645
references.citation: J Cardiothorac Vasc Anesth. 2001 Jun;15(3):326-30
references.pmid: 11426363
references.citation: J Vasc Surg. 1993 Aug;18(2):261-5
references.pmid: 8350435
references.citation: Perfusion. 2007 Sep;22(5):345-52
references.pmid: 18416221
references.citation: Anesth Analg. 2008 Nov;107(5):1487-95
references.pmid: 18931203
references.citation: Coll Antropol. 2008 Mar;32(1):153-60
references.pmid: 18494201
references.citation: Health Technol Assess. 2006 Nov;10(44):iii-iv, ix-x, 1-210
references.pmid: 17049141
references.citation: BMJ. 2002 Jun 1;324(7349):1299
references.pmid: 12039820
references.citation: Acta Anaesthesiol Scand. 1994 May;38(4):336-41
references.pmid: 8067219
references.citation: Anaesth Intensive Care. 1995 Aug;23(4):472-7
references.pmid: 7485940
references.citation: J Orthop Surg (Hong Kong). 2005 Aug;13(2):120-4
references.pmid: 16131672
references.citation: Vestn Khir Im I I Grek. 2003;162(2):59-64
references.pmid: 14606149
references.citation: N Engl J Med. 1999 Feb 11;340(6):409-17
references.pmid: 9971864
references.citation: J Vasc Surg. 1996 Jul;24(1):102-8
references.pmid: 8691512
references.citation: Ann R Coll Surg Engl. 1991 Nov;73(6):381-4
references.pmid: 1759769
references.citation: Ann Thorac Surg. 1996 Jul;62(1):105-8
references.pmid: 8678627
references.citation: Anesthesiology. 2000 Jul;93(1):242-55
references.pmid: 10861168
references.citation: Acta Anaesthesiol Scand. 1997 Sep;41(8):995-1001
references.pmid: 9311397
references.citation: Transfus Med. 2006 Oct;16(5):321-8
references.pmid: 16999754
references.citation: Acta Anaesthesiol Scand. 2005 Oct;49(9):1248-54
references.pmid: 16146460
references.citation: BMJ. 2002 Jul 20;325(7356):143-7
references.pmid: 12130612
references.citation: Ann Thorac Surg. 1993 Jul;56(1):137-41
references.pmid: 8328844
references.citation: Transfusion. 1992 Oct;32(8):742-6
references.pmid: 1412681
references.citation: Ann Fr Anesth Reanim. 1994;13(3):318-25
references.pmid: 7992939
references.citation: Br J Surg. 2004 Nov;91(11):1443-8
references.pmid: 15499651
references.citation: Cah Anesthesiol. 1991;39(3):153-9
references.pmid: 1884268
references.citation: Ann Thorac Surg. 2004 May;77(5):1553-9
references.pmid: 15111142
references.citation: Acta Orthop Scand. 1991 Dec;62(6):557-62
references.pmid: 1767648
references.citation: Semin Cardiothorac Vasc Anesth. 2009 Jun;13(2):122-6
references.pmid: 19617252