title: Autotransfusion in emergent operative trauma resuscitation.
abstract: OBJECTIVE
  Autotransfusion of red cells is common in many surgical specialties. However, this technique is not uniformly used in abdominal trauma. The purpose of this paper is to study the outcomes of patients who were autotransfused during emergency trauma operations in which they sustained full-thickness hollow viscus injury (HVI).
  
  
  METHODS
  A total of 179 patients in period 1999-2008 with penetrating and blunt abdominal trauma requiring intraoperative blood transfusion were evaluated. Recipients of autotransfusion and banked blood (autotransfused group) were compared with recipients of banked blood products only (control group). The t-test, Chi-squared, and Fisher's exact test were used to evaluate the data. Multivariate regression analysis evaluated the primary outcomes, survival and bloodstream infection (BSI).
  
  
  RESULTS
  Of the 179 patients, 108 controls and 71 autotransfused patients were evaluated. The results showed no statistically significant difference between the control and autotransfusion groups regarding age, injury pattern/severity [Injury Severity Score (ISS)], length of stay, postoperative international normalized ratio (INR), and volume of banked blood products. Both groups were also proportional with colon injury. The estimated operative blood loss (EBL) was 2,472 ± 3,261 for controls and 4,056 ± 3,825 for the autotransfused group (p = 0.0001). The total volume of blood transfused was 2,792 and 5,513 for controls and patients in the autotransfusion group, respectively (p = 0.002). Ninety controls (84 %) and 53 autotransfused patients (76 %) survived to discharge (p = 0.21). Twenty controls (49 %) and 17 autotransfused patients (45 %) developed BSI (p = 0.72). Logistic regression analysis revealed that an ISS >25, systolic blood pressure <90, and EBL >2 L predicted mortality. There was also a trend towards decreased survival with age >50 years.
  
  
  CONCLUSIONS
  We found no evidence that emergent autotransfusion worsens clinical outcomes in the setting of concomitant HVI.
authors.affiliation: Department of Vascular Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 652, Rochester, NY, 14642, USA. xzabia_caliste@urmc.rochester.edu.
authors.forename: X A
authors.initials: XA
authors.lastname: Caliste
authors.affiliation: Department of General Surgery, Trauma Service, Washington Hospital Center, 110 Irving Street NW, Room 4B-39, Washington, DC, 20010, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: McArthur
authors.affiliation: Department of General Surgery, Trauma Service, Washington Hospital Center, 110 Irving Street NW, Room 4B-39, Washington, DC, 20010, USA. jack.a.sava@medstar.net.
authors.forename: J A
authors.initials: JA
authors.lastname: Sava
keywords: Abdominal trauma; Autotransfusion; Emergency surgery; Infection; Shock; Trauma systems
references.citation: JAMA. 1984 Jun 22-29;251(24):3283-7
references.pmid: 6727004
references.citation: JACEP. 1978 Apr;7(4):142-4
references.pmid: 633687
references.citation: Ann Emerg Med. 1983 Mar;12(3):180-6
references.pmid: 6338769
references.citation: J Trauma. 1983 Jan;23(1):31-5
references.pmid: 6337267
references.citation: Med Chir Trans. 1818;9(Pt 1):56-92
references.pmid: 20895353
references.citation: J Trauma. 1992 May;32(5):646-52; discussion 652-3
references.pmid: 1588655
references.citation: Transfus Apher Sci. 2001 Jun;24(3):255-9
references.pmid: 11791700
references.citation: World J Surg. 2006 Jun;30(6):1074-80
references.pmid: 16736339
references.citation: J Trauma. 1988 Jun;28(6):855-7
references.pmid: 3385834
references.citation: Am J Surg. 1984 Dec;148(6):782-5
references.pmid: 6439065
references.citation: J Trauma. 1992 Jan;32(1):36-9
references.pmid: 1732572
references.citation: Ann Surg. 1974 Sep;180(3):296-304
references.pmid: 4850165