Authors
R Smith1; 1 The Royal Brompton, UK Objective
Allogenic blood transfusion is associated with infectious and immunological complications. Strategies to reduce a patient’s need for allogenic blood transfusion include cell salvage. It is our practice to routinely use cell salvage technology to retrieve blood contained in an ECMO circuit after discontinuation. We hypothesise that this enhances the haemoglobin concentration in patients without adverse effects and present a retrospective evaluation of our experience. Method
Undertaken at the Adult Intensive Care Unit, Royal Brompton Hospital, UK one of five nationally commissioned respiratory centers. Immediately following removal of the ECMO circuit (Cardiohelp or Levatronix), the circuit blood is transferred to an autotransfusion system (Livanova). The resultant autologous blood is transfused. Data regarding consecutive cell salvage episodes were collected retrospectively from the ICU’s Clinical Information System (ICCA, Philips Healthcare). Results
Data from 100 consecutive cell salvage episodes were collated from 94 patients admitted between July 2016 and January 2017. 81% (n=81) episodes occurred at decannulation. The mean washed red cell volume administered was 255ml (Range: 236-310ml). Mean haemoglobin concentration pre-transfusion was 91.3g/L (+/- 9.7) and rose to 96.3g/L (+/- 10.8) after autologous transfusion. Haemoglobin concentration incremented in 90% (n=94) transfusion episodes. There was a significant correlation between haemoglobin concentration pre-transfusion and following cell salvage; pearson co-efficient 0.81 (95% CI: 0.74-0.87), p<0.0001. There were no reported adverse events. In comparing the volume of blood between the two ECMO circuits we use we found that the mean washed red cell volume administered via Cardiohelp (N=26) was 246ml (IQR: 225-263), whilst that of Levitronix (N=74) was 263ml (IQR: 238-332) Conclusion
Despite a small effect on haemoglobin level, cell salvage has value as part of a broader blood conservation strategy and the avoidance of known risks associated with allogeneic blood transfusion. We advocate for routine cell salvage use. 
