Skip to main content
SpringerLink
Log in

Intraoperative Blood Salvage in Penetrating Abdominal Trauma: a Randomised, Controlled Trial

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Blood is a scarce and costly resource. Transfusion is often required after major trauma but blood may not be readily available, and concerns remain over the potential adverse consequences of allogeneic blood transfusion. Intraoperative blood salvage (IBS) is used extensively after blunt abdominal trauma, but when blood is contaminated by enteric contents its use has been considered contraindicated.

Methods

This was a randomised, controlled trial conducted with Ethical Review Board approval in an inner city trauma unit. Patients with penetrating torso injury requiring a laparotomy and who had exhibited hypotension either pre-hospital or on arrival and in whom there was considered to be significant blood loss were randomly assigned to 2 groups. The control group was given allogeneic blood transfusion at the discretion of the attending medical staff. The cell save (CS) group underwent IBS with transfusion of both allogeneic and autologous blood. All patients received prophylactic antibiotics. The primary outcome was exposure to allogeneic blood up to the first 24 hours postinjury.

Results

Twenty-three patients were entered into the control group and 21 into the CS group. The groups were equivalent in demographic details, injury patterns and injury severity. The mean volume of salvaged blood re-infused in the CS group was 1,493 ml (range 0–2,690 ml). The mean number of units of allogeneic blood transfused in the first 24 hours in the control group was 11.17 compared to 6.47 in the CS group (P = 0.008). Enteric injury had been sustained in 17/23 (75%) of the control group and 18/21 (85%) of the CS group (P = NS). Survival in the control group was 8/23 (35%) compared to 7/21 (33.3%) in the CS arm (P = NS). Patients with documented postoperative sepsis were significantly more likely to die compared to those without sepsis (P = 0.04); however, those patients in the CS arm were no more likely to develop sepsis compared to those who received allogeneic blood alone.

Conclusion

In this randomised, controlled trial for patients with penetrating abdominal injuries, IBS led to a significant reduction in allogeneic blood usage with no discernable effect on rates of postoperative infection or mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 1997;132(6):620–624

    PubMed  CAS  Google Scholar 

  2. Schulman CI, Nathe K, Brown M, et al. Impact of age of transfused blood in the trauma patient. J Trauma 2002;52(6):1224–1225

    PubMed  Google Scholar 

  3. Coupland R. Abdominal wounds in war. Br J Surg 1996;83(11):1505–1511

    PubMed  CAS  Google Scholar 

  4. Smith LA, Barker DE, Burns RP. Autotransfusion utilization in abdominal trauma. Am Surg 1997;63(1):47–49

    PubMed  CAS  Google Scholar 

  5. Vanderlinde ES, Heal JM, Blumberg N. Autologous transfusion. BMJ 2002;324(7340):772–775

    Article  PubMed  Google Scholar 

  6. Napier JA, Bruce M, Chapman J, et al. Guidelines for autologous transfusion. II. Perioperative haemodilution and cell salvage. British Committee for Standards in Haematology Blood Transfusion Task Force. Autologous Transfusion Working Party. Br J Anaesth 1997;78(6):768–771

    PubMed  CAS  Google Scholar 

  7. Timberlake GA, McSwain NE Jr. Autotransfusion of blood contaminated by enteric contents: a potentially life-saving measure in the massively hemorrhaging trauma patient? J Trauma 1988;28(6):855–857

    PubMed  CAS  Google Scholar 

  8. Ozmen V, McSwain NE Jr, Nichols RL, et al. Autotransfusion of potentially culture-positive blood (CPB) in abdominal trauma: preliminary data from a prospective study. J Trauma 1992;32(1):36–39

    PubMed  CAS  Google Scholar 

  9. Gurin NN, Vovk VI, Novitskii LV. Blood reinfusion in penetrating gunshot wounds of the abdomen. Voen Med Zh 1992;(6):10–12

  10. Horst HM, Dlugos S, Fath JJ, et al. Coagulopathy and intraoperative blood salvage (IBS). J Trauma 1992;32(5):646–652

    PubMed  CAS  Google Scholar 

  11. Jeng JC, Boyd TM, Jablonski KA, et al. Intraoperative blood salvage in excisional burn surgery: an analysis of yield, bacteriology, and inflammatory mediators. J Burn Care Rehabil 1998;19(4):305–311

    PubMed  CAS  Google Scholar 

  12. Sloan EP, Nagy K, Barrett J. A proposed consent process in studies that use an exception to informed consent. Acad Emerg Med 1999;6(12):1283–1291

    PubMed  CAS  Google Scholar 

  13. Moore EE, Dunn EL, Moore JB, et al. Penetrating abdominal trauma index. J Trauma 1981;21(6):439–445

    PubMed  CAS  Google Scholar 

  14. Haynes SL, Torella F, Wong JC, et al. Economic evaluation of a randomized clinical trial of haemodilution with cell salvage in aortic surgery. Br J Surg 2002;89:731–736

    Article  PubMed  CAS  Google Scholar 

  15. Van Schaik HD. Penetrating wounds of the abdomen. J Florida Med Assoc 1927;14:33–34

    Google Scholar 

  16. Griswold RA, Ortner AB. The use of autotransfusion in surgery of the serous cavities. Surg Gynaecol and Obstet 1943;77:167–177

    Google Scholar 

  17. Glover JL, Smith R, Yaw PB, et al. Autotransfusion of blood contaminated by intestinal contents. JACEP 1978;7(4):142–144

    PubMed  CAS  Google Scholar 

  18. Smith RN, Yaw PB, Glover JL. Autotransfusion of contaminated intraperitoneal blood: an experimental study. J Trauma 1978;18(5):341–344

    PubMed  CAS  Google Scholar 

  19. Jurkovich GJ, Moore EE, Medina G. Autotransfusion in trauma. A pragmatic analysis. Am J Surg 1984;148(6):782–785

    Article  PubMed  CAS  Google Scholar 

  20. Sugai Y, Sugai K, Fuse A. Current status of bacterial contamination of autologous blood for transfusion. Transfus Apheresis Sci 2001;24(3):255–259

    Article  CAS  Google Scholar 

  21. Ezzedine H, Baele P, Robert A. Bacteriologic quality of intraoperative autotransfusion. Surgery 1991;109(3 Pt 1):259–264

    PubMed  CAS  Google Scholar 

  22. Locher MC, Sailer HF. The use of the Cell Saver in transoral maxillofacial surgery: a preliminary report. J Crani omaxillofac Surg 1992;20(1):14–17

    PubMed  CAS  Google Scholar 

  23. Healy JC, Frankforter SA, Graves BK, et al. Preoperative autologous blood donation in total hip arthroplasty; a cost effectiveness analysis. Arch Pathol Lab Med 1994;118:465–470

    PubMed  CAS  Google Scholar 

  24. Blumberg N, Kirkley SA, Heal JM. A cost analysis of autologous and allogeneic transfusions in hip replacement surgery. Am J Surg 1996;171:324–330

    Article  PubMed  CAS  Google Scholar 

  25. Huber TS, McGorray SP, Carlton LC, et al. Intraoperative autologous transfusion during elective infrarenal aortic reconstruction: a decision analysis model. J Vasc Surg 1997;25(6):984–993

    Article  PubMed  CAS  Google Scholar 

  26. Bilski TR, Baker BC, Grove JR, et al. Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned. J Trauma 2003;54(5):814–821

    Article  PubMed  Google Scholar 

  27. Hess JR, Thomas MJ. Blood use in war and disaster: lessons from the past century. Transfusion 2003;43(11):1622–1633

    Article  PubMed  CAS  Google Scholar 

  28. Hughes LG, Thomas DW, Wareham K, et al. Intra-operative blood salvage in abdominal trauma: a review of 5 years’ experience. Anaesthesia 2001;56(3):217–220

    Article  PubMed  CAS  Google Scholar 

  29. Victorino G, Wisner DH. Jehovah’s Witnesses: unique problems in a unique trauma population. J Am Coll Surg 1997;184(5):458–468

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa

    Douglas M. Bowley, Philip Barker & Kenneth D. Boffard

  2. Department of Surgery, Medical School, 7 York Road, Parktown, 2193, Johannesburg, Republic of South Africa

    Douglas M. Bowley, Philip Barker & Kenneth D. Boffard

  3. UK Defence Medical Services,  

    Douglas M. Bowley & Philip Barker

Authors
  1. Douglas M. Bowley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip Barker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth D. Boffard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas M. Bowley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bowley, D.M., Barker, P. & Boffard, K.D. Intraoperative Blood Salvage in Penetrating Abdominal Trauma: a Randomised, Controlled Trial. World J. Surg. 30, 1074–1080 (2006). https://doi.org/10.1007/s00268-005-0466-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0466-2

Keywords

Search

Navigation