Clinical Efficacy of Intraoperative Cell Saver Autologous Blood Salvage in Emergency Thoracoscopic Surgery for Massive Hemothorax.

Abstract Objectives: The objectives of this study were to investigate the efficacy of intraoperative Cell Saver autologous blood salvage in emergency thoracoscopic surgery for massive hemothorax.methods: Nine consecutive cases, including 8 idiopathic hemopneumothoraxes and 1 late-onset traumatic hemothorax, for which emergency surgery was performed at Uji Tokushu-kai Hospital between 2009 and 2016, were retrospectively reviewed. Results: The median total blood loss was 2200 cc (range, 840–4170 cc). Intraoperative Cell Saver autotransfusion with a median volume of 820 cc was performed in the last 7 patients. The first 2 patients who did not receive an autotransfusion required substantially more allogeneic blood transfusion (10 and 14U, respectively), while the other 7 autotransfusion patients required much smaller amounts of allogeneic transfusion (4 U in 3 and 0 U in 4). Four autotransfusion patients who did not undergo preoperative chest tube drainage and/or who had drainage of < 150cc received a greater amount of intraoperative autotransfusion (mean, 1162 ± 414 cc) than the other 3 patients who had a chest tube drainage of ≥ 150 cc (mean, 666.7 ± 150 cc; P = 0.0574). Torn and bleeding arteries were thoracoscopically clipped in 7 patients. One patient with right lung collapse over 2.5 days developed severe acute respiratory distress syndrome intraoperatively, but fully recovered. Conclusions: Utilizing intraoperative autologous blood salvage with the sparing of preoperative chest tube drainage to the maximum possible extent is an efficient strategy to reduce both overall blood loss and allogeneic blood transfusion in emergency thoracoscopic surgery for massive hemothorax.