Edinburgh Napier University

  Introduction: donor blood is a scarce and expensive
resource, and transfusion is not without risk.1
CEMACH2 and NICE3 have stated that cell salvage
should be considered in major obstetric haemorrhage.
Method: a postal survey of cell-salvage use in
obstetrics of all consultant-led Scottish maternity units,
followed by an identical OAA-approved survey to all
other units across the UK, in 2005-6.
Results: 227 units were surveyed, 176 replied (78%
response); 112 units (64%) use cell salvage in their
hospital in any speciality, but only 67 of the 112 (55%)
use it in obstetrics (38% of total).
These 67 units together performed 119 successful
episodes of obstetric cell salvage in the previous year
and 63 episodes of cell-salvage set-up without
processing blood. There is great variation in the use of
cell salvage between units; 31 of the 67 had not used
cell salvage at all the previous year. Of the 36 (54%)
that had, 13 had used it only once, with only six using it
>8 times.
Lack of training is perceived as the single biggest barrier
to its use (Table 1). Only 51 units (79%) have formal
training programmes. Sharing a cell-salvage machine
kept distant to the maternity unit is another obstacle.
Safety concerns feature less, as amniotic fluid embolism
is realised not necessarily to be due to transfer of fetal
material to the mother.4
Table 1: Perceived barriers to use of cell salvage in obstetrics in units where a cell saver was available in their hospital. More than one reason could be stated per unit.
Lack of training 48%
Safety concerns 10%
Geographical 14%
Financial constraints 5%
Lack of sufficient cases 8%
Only 28 units (43%) audit their use of cell salvage, with
half of these only informally collecting data.
Conclusion: cell salvage is slowly gaining momentum
in obstetrics units but many barriers, especially lack of
training, prevent more uptake of the technique.