UTILITY OF CELL SAVER IN TRAUMA COMPARED TO CARDIAC SURGERY

Objectives: While reperfusion of autologous blood using the Cellsaver (CS) device is routine in cardiothoracic surgery, it is still only used intermittently, with a paucity of evidence-based literature, in trauma. We compared the utility of CS in these two distinct populations within the same institution, to explore current status as well as the potential benefit of greater CS use in trauma.

Methods: Retrospective review of CS use at a Level 1 trauma center 2017-2022. Volume of blood salvaged, reinfused, total and allogenic blood transfusion volume were compared between trauma (general & orthopedic) & cardiac surgery cases. Cost of CS deployment & auto-transfusion was compared to cost of allogenic blood from blood bank. Winsorized data was analyzed via Kruskal Wallis tests and χ2 tests with multiple pairwise comparisons. Family-wise error rate maintained at 0.05.

Results: CS was successfully used in 97% of cardiac surgical cases, compared to around 74% in trauma. The proportion of blood requirements provided by CS, compared to allogenic transfusion, was also significantly higher in cardiac surgery. However, there was still net benefit for CS in trauma surgery, with median salvaged transfusion volume of at least one unit, in both general & orthopedic trauma. At this institution, CS deployment cost $70, while CS deployment with auto-transfusion cost $150. Each unit of pRBC from blood bank cost $210. Therefore, auto-transfusion of even one unit of pRBC would result in cost savings, compared to allogenic transfusion.

Conclusion: The controlled setting of cardiac surgery leads to greater success at retrieving and transfusing salvaged blood than in trauma surgery. However, CS deployment in trauma surgery is feasible in many cases, and reduces the need for allogenic transfusion.