Describe the indications for use of intraoperative cell salvage.
Intraoperative cell salvage has been used in a variety of surgical settings, and its ability to reduce homologous blood use is well documented. Intraoperative cell salvage is indicated in cases for which blood loss is expected to exceed 1,000 mL.
Many, though not all, Jehovah’s Witnesses will accept cell salvage, and it may be used in cases where obtaining homologous blood is difficult because of rare blood types or multiple antibodies. Cases ideally suited for cell salvage are those where surgical bleeding is confined to a discrete area. Blood loss occurring slowly over a wide area is diffi-cult to collect. Typically, because of losses from the surgical field and those occurring during processing, approximately 50% of shed blood is returned to the patient. Recovery may be higher in some cases, such as abdominal aortic aneurysm resection, where blood loss is well localized. Use of intraoperative cell salvage has had a great impact in vascular surgery, orthopedic surgery, and cardiac surgery. It has also been commonly used in urologic, trauma, trans-plantation, and neurosurgical procedures. Not only has the average homologous blood requirement decreased, but the percentage of patients requiring no homologous blood products has sharply increased, from 4% to 68% in one study involving vascular surgery patients. Another study from a major center demonstrated that 17% of the total institutional red cell requirement was obtained by intra-operative cell salvage.