Barriers and facilitators to cell saver use in damage control surgery

BACKGROUND: Cell savers reduce the use of allogeneic blood and can serve as an important adjunct during blood shortages. This study investigates the user perspective on cell saver (CS) use during damage control surgery (DCS) in the Netherlands. STUDY DESIGN AND METHODS: A survey was conducted amongst trauma surgeons and anesthesiologists from Dutch level 1 trauma centers and military-affiliated hospitals. The survey assessed the perceived usability and usefulness of CS in DCS, addressing factors such as logistics, training, experience, (contra)indications, and perceived suitability of CS or reinfusion of unwashed salvaged blood during blood shortages. Responses were analyzed using a five-point scale. RESULTS: 195 of the 707 (28%) invited clinicians completed the survey. Most rated CS as very useful or essential during DCS (trauma surgeons: 58%, anesthesiologists: 64%). Staff (90%) and disposables (84%) were reportedly available, but reported concerns included CS being time-consuming (trauma: 23%, anesthesia: 40%), contamination risk from gastrointestinal injuries (trauma: 37%, anesthesia: 21%), and insufficient suction power (trauma: 19%, anesthesia: 10%). During blood shortages, most respondents considered CS suitable for DCS (trauma: 54%, anesthesia: 63%), but fewer supported reinfusion of unwashed salvaged blood (trauma: 62%, anesthesia: 25%). DISCUSSION: The routine use of CS during DCS may be hampered by practical and clinical barriers, such as time constraints, limited training, and the risk of complications. Targeting these areas and correlating these findings to clinical outcomes may increase the use of autologous blood transfusion techniques.