Is surgical smoke a relevant contamination for salvaged autologous blood? A pilot study.

Abstract

Background and objectives: Electrocautery-related surgical smoke removed together with the intraoperative blood collection through suction devices might be a potential hazard. The degree of contamination of the autologous blood despite cell recovery and its possible harm to the patient remain subjects of research.

Materials and methods: Two types of laboratory experiments and one clinical study were conducted. Initially, toluene was added to banked erythrocytes mixed with fresh frozen plasma. This reconstituted blood was processed using the autotransfusion device XTRA, and the elimination of toluene was calculated via gas chromatography (GC). In a second experiment, slices of pigskin were cut with electrocautery while dropping reconstituted blood onto the cauterization point. The resulting smoke and the blood were sucked into a cell salvage reservoir and washed with the XTRA. Samples from the reservoir and the product were analysed by GC. The average elimination rate was calculated. In a clinical study, blood samples were collected from the reservoir of the cell saver system during cardiac surgery and analysed likewise.

Results: The autotransfusion device removed 92% of toluene from the processed blood. Other unidentified contaminants showed an elimination rate above 97.9%.

Conclusion: Cell salvage devices significantly reduce the amount of contaminants in wound blood. Nevertheless, despite this highly effective detoxication, the remaining contaminants may still pose a potential risk to the patient.