Intraoperative cell salvage in ruptured abdominal aortic aneurysms

Abstract

Aim. The aim of this study was to evaluate the impact of intraoperative cell salvage (ICS) on the early outcome after open repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods. This is a retrospective review of 73 consecutive patients who underwent emergency OR of infrarenal rAAA with ICS between 2005 and 2008 (Group I), compared to 51 repairs from 2002-2004 with no ICS (Group II). In addition, a transfusion protocol of platelets and fresh frozen plasma (FFP) administration on admission and during surgery was adopted in patients in Group I to maintain coagulation competence. Results. ICS reduced bank blood demand by 63.6% (from 11 to 4 units, P<0.001) compared to controls, and had a strong impact on rates of postoperative complications (P=0.05), or death (43.8% vs. 52.9%, P<0.05) or in-hospital LOS (P<0.07) in these patients. Patients surviving in Group I had significantly higher postoperative haemoglobin level (11.5 vs. 9.6 g/dL, P<0.05) and platelet count (267 vs. 95 x 109 L, P<0.001 ), a shorter APTT (31 s vs. 47 s, P<0.05) and a lower INR (1.3 vs. 2.1, P<0.01) than patients who died postoperatively. ICS volume was significantly higher in patients with suprarenal aortic clamping and in those who had bifurcated grafting reconstruction (P<0.05), but amount of red blood cells (RBC) collected did not influence outcome. Conclusion. These results suggest that intraoperative cell salvage, minimizing perioperative homologous blood transfusion, is an important determinant of outcome after rAAA repair. Combined administration of balanced blood components may contribute to improve the survival of the patients