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Use of Cell Salvage at the time of Cesarean Delivery: A Meta-analysis of Randomized Controlled Trials
Iyer, N. S., Khanuja, K., Roman, A., Al-Kouatly, H. B.
American journal of obstetrics & gynecology MFM. 2023;:101257
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.
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Intraoperative Cell Salvage for Women at High Risk of Postpartum Hemorrhage During Cesarean Section: a Systematic Review and Meta-analysis
Obore N, Liuxiao Z, Haomin Y, Yuchen T, Wang L, Hong Y
Reproductive sciences (Thousand Oaks, Calif.). 2022
Abstract
Postpartum hemorrhage (PPH) can lead to substantial blood loss that compromises maternal hemodynamic stability and consequently cause severe maternal complications such as organ dysfunction or death. Intraoperative cell salvage (IOCS), an effective method of blood conservation used in other surgical specialties, can be an alternative intervention for managing PPH. Thus, our aim was to evaluate the efficacy and safety of IOCS for women at high risk of PPH undergoing cesarean sections. We conducted a systematic search of electronic databases from inception to February 25, 2021 for randomized controlled studies and observational studies published in English or Mandarin about IOCS use in cesarean sections. Primary outcomes of interest were changes in postoperative hematologic parameters and any adverse events reported among patients that had IOCS and controls that had an allogeneic blood transfusion. The certainty of the evidence of the outcomes was evaluated using the GRADE approach. A total of 24 studies with 5872 patients were included in the meta-analysis. Eleven randomized controlled trials (RCTs), and 13 observational studies were analyzed. Postoperative hemoglobin levels were higher among patients with IOCS SMD 0.39 (95% CI; 0.20, 0.60; P < 0.001, high certainty). Allogeneic blood transfusion increased adverse events RR = 1.81(95% CI; 1.24, 2.62; P = 0.002, low certainty). IOCS shortened hospital stay SMD - 0.59 (95% CI: - 0.98, - 0.19; P = 0.004, low certainty) and shortened prothrombin time SMD - 0.67 (95% CI; - 1.31, - 0.04), P = 0.037, low certainty). The lower incidence of transfusion-related adverse events and shorter hospital stay among other findings demonstrate that IOCS use in obstetrics is an effective and safe alternative for the management of PPH; however, high-quality randomized control studies are required to confirm this evidence.
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Does current evidence support the use of intraoperative cell salvage in reducing the need for blood transfusion in caesarean section?
Dhariwal SK, Khan KS, Allard S, Wilson M, Moore P, SALVO study group
Current Opinion in Obstetrics & Gynecology. 2014;26((6):):425-430.
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Abstract
PURPOSE OF REVIEW An important cause of maternal morbidity and direct maternal death is obstetric haemorrhage at caesarean section. Concerns regarding allogeneic blood safety, limited blood supplies and rising health costs have collectively generated enthusiasm for the utility of methods intended to reduce the use of allogeneic blood transfusion in cases of haemorrhage at caesarean section. This can be achieved by intraoperative cell salvage (IOCS). The aim of this review is to summarize and examine the evidence for the efficacy of IOCS during caesarean section, in women at risk of haemorrhage, in reducing the need for allogeneic blood transfusion. RECENT FINDINGS The majority of the evidence currently available is from case reports and case series. Although this evidence appears to support the use of IOCS in obstetrics, strong clinical evidence or economic effectiveness from clinical trials are essential to support the routine practice of IOCS in obstetrics. SUMMARY Current evidence is limited to reported case series and two small controlled studies. Overall, IOCS may reduce the need for allogeneic blood transfusions during caesarean section. Future large randomized trials are required to assess effectiveness, cost effectiveness and safety. The results of the current ongoing SALVO (A randomised controlled trial of intra-operative cell salvage during caesarean section in women at risk of haemorrhage) trial will shed light on these aspects.