Association of Anaesthetists guidelines: cell salvage for peri‐operative blood conservation 2018

1. The use of cell salvage is recommended when it can be expected to reduce the likelihood of allogeneic (donor) red cell transfusion and/or severe postoperative anaemia.
2. We recommend that cell salvage equipment and staff trained to operate it be immediately available 24 h a day in hospitals undertaking surgery where blood loss is a recognised complication.
3. Collection of blood for potential cell salvage (‘collect only’ mode) should be considered for surgical procedures where blood loss may exceed 500 ml (or > 10% of calculated total blood volume) in adult patients, or > 8 ml.kg⁻¹ (> 10% of calculated total blood volume) in children weighing > 10 kg.
4. Each hospital should have both a nominated clinical lead and a coordinator for cell salvage, who oversee a competence‐based training programme for all involved staff, along with ongoing data collection and audit.
5. When the use of cell salvage is proposed in surgery for malignancy or infection, an explanation should be given to the patient of the potential risks and benefits and specific consent should be obtained.
6. The use of leucodepletion filters should be considered during re‐infusion of salvaged blood in cancer surgery and when blood is salvaged from an infected surgical field. There is mixed evidence of the benefit of leucocyte depletion filters in obstetrics.
7. Current evidence does not support the routine use of cell salvage during caesarean section. Cell salvage should be considered in the ‘collect only’ mode in women undergoing caesarean section who are anaemic before surgery, in women anticipated to be at high risk of haemorrhage or if unanticipated bleeding develops during surgery.

What other guideline statements are available on this topic?

These guidelines update previous Association of Anaesthetists guidelines on intra‐operative cell salvage published in 2009. The National Institute for Health and Care Excellence (NICE) published guidelines for intra‐operative cell salvage in obstetrics in 2005 and in urology in 2008. The UK Cell Salvage Action Group has published guidance and other resources. In Australia, the National Blood Authority has published relevant guidance. Most recently, the NICE transfusion guidelines refer to cell salvage.

Why were these guidelines developed?

These guidelines were developed to inform, support and encourage the appropriate increased use of cell salvage as part of a blood conservation (Patient Blood Management) programme.

How and why does this statement differ from existing guidelines?

This guideline recommends wider use of cell salvage, and recommends that cell salvage should be universally available in hospitals performing major surgery.