Use of Cell Salvage at the time of Cesarean Delivery: A Meta-analysis of Randomized Controlled Trials

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, 19107. Electronic address: neel.iyer@jefferson.edu. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, 19107.

American journal of obstetrics & gynecology MFM. 2023;:101257
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Abstract
OBJECTIVE Excess blood loss from obstetrical hemorrhage requires transfusion of donor blood, a finite resource. Intraoperative cell salvage collects a patient's own blood that has been lost during cesarean delivery and returns it to their own circulation. We performed a meta-analysis to examine the perioperative outcomes in patients receiving cell salvage at the time of cesarean delivery. DATA SOURCES Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, and clinicaltrials.gov were searched from database inception through October 2023. STUDY CRITERIA Randomized controlled trials comparing the use of cell salvage to standard of care during cesarean delivery. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently extracted data. PRISMA guidelines were used for data extraction and quality assessment. Primary outcomes were the rate of donor blood transfusion and change in hemoglobin level. Secondary outcomes included transfusion reaction, amniotic fluid embolism, and length of hospital stay. Results were summarized as weighted mean difference (MD) or risk ratio (RR) with associated 95% confidence intervals. Heterogeneity was measured using Higgins I(2). RESULTS A total of four RCTs (n=3231) comparing cell salvage to standard care during cesarean delivery met inclusion criteria. Primary analysis showed a significant decrease in receiving allogeneic blood transfusion with intraoperative cell salvage use versus standard care (OR 0.61, 95% CI [0.41,0.92]), with no change in hemoglobin drop (MD -1.03, 95% CI [-2.78,-0.72]). Secondary outcomes showed no difference in transfusion reaction (OR 0.56, 95% CI [0.06,5.59]), and length of hospital stay (MD -1.90, 95% CI [-4.85,1.06]). No cases of amniotic fluid embolism were reported among the 1620 patients who received cell salvage. CONCLUSION Use of cell salvage during cesarean delivery reduced the overall need for allogeneic blood transfusion without increasing the risk of complications including no cases of amniotic fluid embolism.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine