Purpose of review The collection of shed blood and its reinfusion has been termed 'cell salvage' or 'autotransfusion'. This review will summarize the historical foundation of cell salvage and summarize recent literature associated with cell salvage use in trauma. Recent findings There have been no publications on cell salvage in trauma during the last 2 years. This is based on a PubMed search using the key words, 'cell salvage', 'autologous blood transfusion' and 'operative blood salvage'. Although the wars in Iraq and Afghanistan were ongoing, publications focused upon autotranfusion of unwashed blood from the hemothorax and on the resuscitation of the injured in remote settings. Summary Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.

Cell salvage in trauma.

Many surgeons in the world work in austere environment. This condition is very challenging. Every surgeon, working in these difficult situations, should have the basic knowledge to deal with all the problems he may encounter. The aim of this chapter is to provide the healthcare provider managing an acute care surgery (ACS) patient in resource-limited settings with tricks that could be useful in facing some of the shortcomings related to their specific conditions of practice.

The ACS Patient in Resource-Limited Setting: How to Get the Maximum from the Minimum!

BACKGROUND In case of a warm fresh whole blood transfusion on the battlefield, the blood donation usually occurs just after a combat phase and often after several days on the fields. To explore the hemostatic capacity of such blood, we analyzed the blood of volunteers attending the commando course of the French Navy, considering this course as an experimental model, placing them into the same physiological conditions as those faced by deployed fighters. METHODS Venous blood was collected at the beginning of the course, mimicking their baseline status, and a second time 6 weeks later, from the remaining candidates, during the actual commando training, mimicking the stress conditions. For each candidate, we observed the differences between the two blood samples. RESULTS Of the 112 men that attended the first day of the course, only 17 remained 6 weeks later. In the second blood samples, we noted significant increased leucocytes and platelets counts and significant decreased hematocrit and hemoglobin levels. Thrombin generation assays showed significantly lower normalized peak heights (-31%), lower normalized endogenous thrombin potential values (-29%), and lower velocity index (-35%). Normalized lag time and time to peak did not differ. Viscoelastometric testing revealed a significant increasing in clot firmness as assessed by maximum amplitude and amplitude at 6 minutes. The clot speed was significantly increased. CONCLUSION This work brings new data on coagulation during prolonged and considerable physical exercise. No obvious deleterious modification of hemostatic properties was observed. The decrease of the endogenous thrombin potentials may reflect a better ability to control the thrombin generation once started. Altogether, these results suggest that this blood could suit well a hemorrhagic war-injured patient. LEVEL OF EVIDENCE Prospective observational cohort study, Level III.

Evaluation of hemostatic capacities among commando candidates: Would their blood suit a hemorrhagic war-injured patient in case of blood donation on the battlefield?

Massive hemothorax is a life-threatening condition that can present as hemorrhagic shock, cardiogenic shock, or elements of both. It is described by the American College of Surgeons, in the 9th Edition of Advanced Trauma Life Support, as a rapid accumulation of more than 1,500 mL of blood or one-third or more of the patient's blood volume. The use of autotransfusion systems has been implemented for the treatment of hemothorax in hospital settings. The implementation of autotransfusion has been documented in situations where an extended period can elapse before definitive treatment can occur. This article is the first described case where an autotransfusion system has been implemented in a prehospital setting, at a Role 1 medical facility, for massive hemothorax in Afghanistan.

/pdf/consider-autotransfusion-in-the-field-s48txyn9lt.pdf

Jared Bernard

Papers

Consider Autotransfusion in the Field