Does autotransfusion from a contaminated trauma laparotomy field increase the risk of complications?

BACKGROUND

Autotransfusion (AT) in trauma laparotomy is limited by concern that enteric contamination (EC) increases complications, including infections. Our goal was to determine if AT use increases complications in trauma patients undergoing laparotomy with EC.

METHODS

Trauma patients undergoing laparotomy from October 2011-November 2020 were reviewed. Patients were excluded if they did not receive blood in the operating room, did not have a full thickness hollow viscus injury, or died <24 h from admission. AT and non-AT patients were matched. Outcomes were compared.

RESULTS

185 patients were included, 60 received AT, and 46 pairs were matched. After matching, demographics were similar. No differences were noted in septic complications (33 vs 41%, p = 0.39), overall complications (59% vs 54%, p = 0.67), or mortality (13 vs 6%, p = 0.29).

CONCLUSIONS

AT use in contaminated trauma laparotomy fields was not associated with a higher rate of complications.

Effects of a targeted blood management programme on allogeneic blood transfusion in abdominal aortic aneurysm surgery

OBJECTIVES

To investigate the impact of a dedicated cell salvage practitioner team on blood loss and allogeneic transfusion in abdominal aortic aneurysm (AAA) surgery.

BACKGROUND

Cell salvage reduces allogeneic transfusion in AAA surgery, but is commonly performed by the anaesthetic nurse. At our hospital, a dedicated patient blood management practitioner is present for all elective open AAA repairs.

METHODS/MATERIALS

Data were collected on 171 AAA patients operated on at the John Radcliffe Hospital, Oxford over a 3-year period, looking at the Patient Blood Management processes, including: blood loss, cell salvage, near-patient testing (thrombelastography) and transfusion rates of allogeneic blood products.

RESULTS

Blood loss ranged from 3-108% of estimated blood volume (EBV) (median 25% = 1500 mL). In seven patients who lost 70-110% of their EBV, none reached the thrombelastography intervention threshold for R time (11 min) or MA (48 mm) despite such massive blood loss. Overall, only 7/171 (4%) patients received intra-operative allogeneic blood, all of whom had a mean baseline haemoglobin concentration < 106 g L^-1 (median 98, range 95-105 g L^-1 ). In terms of other blood products, only 4/171 (2·3%) received one unit of platelets each intra-operatively. None received FFP or cryoprecipitate.

CONCLUSIONS

Such low levels of allogeneic transfusion have not been reported previously. We hypothesise that this is due to the additional blood management contributions of the specialised cell salvage practitioners and collaboration with the rest of the vascular surgical team. These results support the development of pre-operative anaemia clinics. Overall the service runs at a profit to the trust.

Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe

BACKGROUND

The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax.

METHODS

This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury.

RESULTS

A total of 272 patients (AT, 136; No-AT, 136) were included. There was no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group.

CONCLUSION

The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.

LEVEL OF EVIDENCE

Epidemiologic/prognostic study, level III.