(1505) Cell Salvage in the ICU: Autologous Blood Salvage via Vacuum-Assisted Closure Devices

Introduction: Autologous blood transfusion via washed red blood cell salvage can reduce allogenic transfusion needs when used in uncontaminated procedures; however, this is frequently confined to the operating room. We here report results of cell salvage via vacuum-assisted closure (VAC) devices as part of a damage control resuscitation strategy in the intensive care unit (ICU).

Methods: We retrospectively identified 5 patients admitted to a single surgical ICU with ongoing coagulopathic bleeding after abdominal or chest surgery who underwent temporary VAC incisional closure and ICU cell salvage. An adapter was fashioned to link the VAC outflow to cell salvage inflow using sterile equipment readily available at bedside. Charts were reviewed for operative and ICU transfusion, coagulation measures, and clinical outcomes.

Results: Two liver transplant and three penetrating trauma patients were identified who underwent damage control surgery (4 abdominal and 1 bilateral chest procedures) with VAC closure: 60% were coagulopathic by intraoperative thromboelastography; mean end-operation temperature was 34.1 degrees Celsius, pH was 7.16, and lactate was 7.4. Intraoperative transfusions included a mean of 7.8 red cell, 6.2 plasma, and 1.6 platelet units, with 883 mL of intraoperative cell salvage. In the ICU, mean total red cell transfusion volume was 3.3L, of which VAC-salvaged red cells accounted for a mean of 1.4L (43.5%) of red cell volume transfused. Although not prospectively assessed, indirect bilirubin levels on 2 patients within 48 hours of VAC cell salvage were normal, suggesting negligible hemolysis related to the salvage procedure.

Conclusions: Autologous cell salvage during damage control surgery is an important tool for reducing allogeneic blood usage. Here we show the feasibility and utility of ICU bedside cell salvage in selected cases, with significant conservation of blood bank resources and reduction in allogeneic antigen exposure. Techniques such as this require expansion in order to conserve increasingly limited blood bank resources, and may have important implications for austere and resource-limited settings.