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.
An evaluation of clinical aspects of post-operative autotransfusion, either alone or in conjunction with pre-operative aspirin, in cardiac surgery.
Two groups of 21 otherwise healthy patients undergoing coronary artery bypass grafting (CABG) for the first time were studied in order to evaluate the advantages and disadvantages of post-operative autotransfusion using a red cell 'salvage' method. Group 1 patients (control group) were transfused using donor blood only. Group 2 patients were transfused with their own (autologous) blood, salvaged post-operatively, although donor blood was also available to them if needed. The two groups were further subdivided according to whether the patients received aspirin pre-operatively or not. The four subgroups thus formed were comparable pre- as well as intra-operatively, with respect to all available clinical and laboratory criteria. The post-operative data, however, showed that the combination of pre-operative aspirin and autotransfusion leads to excessive post-operative bleeding, together with increased donor blood requirement. It was also shown that autotransfusion without aspirin does reduce the need for donor blood transfusion without any increase in post-operative bleeding. Although aspirin alone did not increase post-operative bleeding or donor blood requirement, its combination with autotransfusion should be avoided.