Use of cell salvage at time of cesarean section: a systematic review and meta-analysis

Excess blood loss from obstetrical hemorrhage requires transfusion of donor blood, which is a finite resource. Cell salvage collects the patient’s own blood that has been lost during cesarean and returns it to her own circulation. We performed a systematic review and meta-analysis to examine the perioperative outcomes in patients receiving cell salvage at the time of cesarean delivery. Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, and ClinicalTrials.gov were searched from database inception to June 2022. Inclusion criteria were randomized controlled trials (RCTs) comparing use of cell salvage to standard care during cesarean delivery. Primary outcomes were 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. Quality of study and risk of bias were evaluated for all studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Heterogeneity was measured using Higgins I2. 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 individuals receiving donor blood transfusion with routine cell salvage use versus standard care (OR 0.65, 95% CI [0.44,0.96], I2=45%), with no change in hemoglobin drop (MD -1.03, 95% CI [-2.78,-0.72], I2=91%). Secondary outcomes showed no difference in transfusion reaction (OR 0.65, 95% CI [0.04,8.81], I2=72%), and length of hospital stay (MD -1.90, 95% CI [-4.85,1.06], I2=100%). No cases of amniotic fluid embolism were reported among the 1620 patients who received cell salvage. Use of cell salvage during cesarean delivery may reduce overall need for donor blood transfusion, without increasing risk of complications, particularly when used during routine cesarean delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)