title: Intraoperative cell salvage in a combat support hospital: a prospective proof of concept study.
abstract: BACKGROUND
  Provision of transfusion support is an important element of contemporary military operations, but presents a considerable logistic burden. Intraoperative blood salvage (IBS) offers the potential to reduce dependency on donated red blood cell (RBC) supply. The aim of this study was to assess the feasibility of IBS in an operational environment.
  
  
  METHODS
  A "salvage-only" IBS feasibility study was undertaken in a deployed, Anglo-American combat support hospital. All adult patients admitted with combat-related injuries likely to require more than 10 units of RBCs in 12 hours were included. The volume of salvaged blood available for reinfusion was collated with injury type.
  
  
  RESULTS
  A total of 130 patients were admitted having sustained combat-related injury. Twenty-nine fulfilled the criteria, of which 27 were identified on admission. Eighteen cases were selected for IBS and salvage was completed in 17. From these 17, the mechanism of injury was 24% gunshot wound (GSW) and 76% blast injury, and injury type was 47% body cavity and 53% extremity. A total of 5578g RBC mass was salvaged and prepared for reinfusion, representing 7.6% of total requirement. The proportion of RBC mass salvaged to that required was greatest in those with GSWs and cavity injuries, being 39% (673g/1733g) and 16% (243g/1497g), respectively.
  
  
  CONCLUSIONS
  Salvage is most successful in patients with GSWs and cavity injuries and less appropriate for limb and blast injuries. However, the results of this study present more arguments against IBS than for it, and further research is needed to determine its safety in combat settings.
authors.affiliation: Joint Force Hospital, Camp Bastion, Afghanistan, Op HERRICK, BFPO 792.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.forename: Dmitri
authors.initials: D
authors.lastname: Nepogodiev
authors.forename: Heidi
authors.initials: H
authors.lastname: Doughty
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Bowley
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult