Current concepts in the use of cell salvage in obstetrics.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Current Opinion in Anesthesiology Pub Date : 2024-06-01 Epub Date: 2024-03-12 DOI:10.1097/ACO.0000000000001337
Vanessa Neef, Patrick Meybohm, Kai Zacharowski, Peter Kranke
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引用次数: 0

Abstract

Purpose of review: The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed.

Recent findings: Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage.

Summary: Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.

在产科中使用细胞抢救的当前概念。
审查目的:孕产妇大出血是导致孕产妇死亡的全球主要原因。孕产妇大出血可导致整个血容量的损失。在过去的二十年中,患者血液管理不断发展,以改善患者的护理和安全。在失血量超过 500 毫升的手术中,强烈建议使用细胞挽救术,以保存患者自身的血容量,并尽量减少异体红细胞(RBC)输注的需要。本综述讨论了产科使用细胞复苏的最新证据和争议:摘要:术中细胞复苏是一种维持患者自身血容量并减少异体红细胞输注需求的策略。从历史上看,由于担心先天性羊水栓塞(AFE)或诱发母体同种异体免疫,产科人群一直避免使用细胞复苏。然而,迄今为止尚未有明确的羊水栓塞病例报道。对于失血率和红细胞输注率较高的患者,如胎盘早剥谱系障碍的产妇,强烈建议进行细胞复苏,这样做既经济又有效。然而,为了确保在多专业产科环境中获得足够的实践经验,似乎最好是自由使用细胞复苏。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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