The impact of routine intraoperative cell salvage use for lower segment cesarean section during the Covid-19 Pandemic

ABSTRACT

Background: Blood services have been challenged to maintain their inventory during COVID-19. An expert group issued a 'Call to Action' to all stakeholders to implement practical, multimodal principles of Patient Blood Management (PBM). Intraoperative cell salvage (IOCS) is central to PBM also for lower segment cesarean section (LSCS). Prior to April 2020, we initiated IOCS during LSCS based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated IOCS to reduce blood product usage. We examined the impact of routine IOCS on the incidence and degree of post-partum anemia, transfusion, and other maternal outcomes. Methods: We conducted a single-centre before-and-after study of obstetric patients undergoing LSCS in the 2 months prior to change in practice ('usual care', n=203) and the 2 months following ('mandated IOCS', n=228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Data were analysed using t-tests for normally distributed continuous data (else Mann Whitney U-tests) and Chi Squared test for frequency data. Post-operative iron infusion and length of stay (log-transformed) were modelled using logistic and linear regression, with inverse probability weighting to account for potential confounders. Results: Maternal demographics were similar between groups. (Table 1). More emergency LSCSs occurred in the usual care group. Compared to the Usual Care group, post-operative Hb was higher, and anemia cases, frequency of IV iron and length of stay were all lower in the Mandated IOCS group (Table 2). After statistical modelling, rates of post-partum iron infusion were significantly lower in the Mandated IOCS group but there was no difference in length of stay. Conclusion: Routine cell salvage provision during LSCS resulted in increased post-partum Hb and reduced anemia prevalence. This translated into a reduction in post-partum iron infusions. IOCS for LCSC may contribute to an avoidance of limited blood service products. (Table Presented) .