Cell Salvage in Orthopedic Surgery

Effectiveness of Cell Salvage

The American Society of Anesthesiologists recommends cell salvage in orthopedic surgery as a safe and effective blood conservation strategy, with cell salvage devices not causing the same level of blood cell damage as those used during cardiac surgery 1, 2
Cell salvage in orthopedic procedures significantly reduces allogeneic blood transfusion requirements, with a relative risk of 0.39 (95% CI = 0.30-0.51) 6, 7
Intra-operative cell salvage significantly reduces red cell transfusion exposure rate and volume of allogeneic red cells transfused in hip and knee arthroplasties 1, 7

Cell salvage should be considered in all orthopedic or trauma surgery when blood loss is expected to be > 500 ml, with important precautions to maintain blood quality, including not using cell salvage while bone cement is being applied 1, 6
Precautions to maintain blood quality in orthopedic surgery include resuming cell salvage when cement is fully set, using standard suction until the surgical field has been irrigated and metal fragments removed in revision surgery, and avoiding cell salvage while the surgical field is contaminated with antibiotics, iodine, or topical clotting agents 6, 7

During cardiac bypass, cardiotomy suckers can lead to depletion of clotting factors and platelets, and the use of cell salvage during bypass is not recommended due to resulting depletion of clotting factors and platelets 2, 3
After bypass, 500-1000 ml of blood remains in the bypass circuit, which when returned unprocessed may contribute to coagulation issues 4, 5