Abstract
Purpose
To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery.
Source
We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001. The search included textword searches using “autotransfusion,” “cell salvage,” “device,” or Medical Subject Headings “autologous blood transfusion” or a “randomized controlled trials” filter.
Principal findings
Five randomized controlled trials (RCT) were identified involving cell salvage and vascular surgeries. In infra renal abdominal aortic aneurysm surgery the risk ratio (the risk of receiving at least one unit of allogeneic red cells) was 0.37 [95% confidence intervals (CI) of 0.06 to 2.36]. In elective aorto-femoral bypass surgery the risk ratio was 0.97 (95% CI of 0.66 to 1.42). The pooled risk ratio for cell salvage in vascular surgery was 0.67 (95% CI of 0.35 to 1.28).
Conclusion
Cell salvage, a commonly used technique to recover red cells from the operative field, has been the subject of several studies in vascular surgery. There is insufficient evidence to recommend the routine use of cell salvage in elective abdominal aortic aneurysm and aorto-femoral bypass surgeries. A large RCT would elucidate whether cell salvage is effective as a blood conservation technique.
Résumé
Objectif
Déterminer si la récupération de sang réduit le nombre de patients qui recevront au moins une unité de concentré de globules rouges allogènes en période périopératoire d’une intervention chirurgicale vasculaire réglée.
Source
Les articles pertinents ont été repérés par des recherches électroniques combinées dans MEDLINE et EMBASE, la bibliothèque Cochrane et une recherche manuelle des essais cliniques randomisés et des exposés de synthèse. La recherche électronique comprend des articles publiés entre 1966 et avril 2001 à partir des termes «autotransfusion», «cell salvage», «device» ou de mots clés du domaine médical comme «autologous blood transfusion» ou d’un filtre sur les «randomized controlled trials».
Constatations principales
Nous avons trouvé cinq études randomisées et contrôlées (ERC) comportant la récupération de sang et la chirurgie vasculaire. L’opération d’un anévrysme aortique abdominal infrarénal présentait un taux de risque (le risque de recevoir au moins une unité de globules rouges allogènes) de 0,37 [intervalle de confiance (IC) de 95 % de 0,06 à 2,36]. Le risque lié au pontage aortofémoral réglé était de 0,97 (IC de 95 % de 0,66 à 1,42). Le risque commun en chirurgie vasculaire était de 0,67 (IC de 95 % de 0,35 à 1,28).
Conclusion
La récupération de sang, couramment utilisé pour conserver les globules rouges provenant du champ opératoire, a fait l’objet de quelques études en chirurgie vasculaire. Il n’y a pas de preuve suffisante pour recommander la récupération régulière de sang lors d’opérations pour anévrysme aortique abdominal et de pontages aorto-fémoraux. Une importante ERC pourrait préciser si la récupération de sang est efficace comme technique de conservation du sang.
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Alvarez, G.G., Fergusson, D.A., Neilipovitz, D.T. et al. Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review. Can J Anesth 51, 425–431 (2004). https://doi.org/10.1007/BF03018303
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DOI: https://doi.org/10.1007/BF03018303