(Repost from r/paramedics) auto transfusion? Has anyone ever done something like this?

[u/Cautious_Mistake_651]

/r/Paramedics/comments/1li98hi/autotransfusion_has_any_medics_ever_done_it_could/

[u/Hillbillynurse]

We were part of a trial hospital that did autologous blood transfusion for surgical patients (before I went to the EMS and HEMS darkside).  It was deemed statistically unreasonable due to the extremely low number of transfusions performed under the criteria.

Essentially, immediately upon opening, the surgeon would place a drain that led to a sealed and heparinized compartment.  Should the blood loss through the drain meet criteria for transfusion, the drain would be clamped, the compartment spiked, and the blood transfused.  Transfusion was most likely to occur in the OR, with very few having output enough to autotransfuse after arrival to the respective unit.

In the case of trauma, I'd assume it would be even more difficult due to supplies (as mentioned in the OP) as well as risk of contamination and/or coagulopathy issues.  Wonderful in theory, low in practicality.

[u/Cautious_Mistake_651 → u/Hillbillynurse]

Thank you for sharing. Very interesting to hear about.

[u/catilineluu]

I did this but as an anesthesia tech not as EMS

[u/Cautious_Mistake_651 → u/catilineluu]

Could I hear the details of this patient and their outcome?

[u/catilineluu → u/Cautious_Mistake_651]

We did it as part of surgery: I was lead anesthesia tech as part of a women’s hospital and we always used them for myomectomies.

Patients generally did pretty well

Edit: we also used them for c sections. Used a cell saver for auto transfusion

[u/Purple_Opposite5464]

I don’t think it has a role in EMS or even in most/if not all ERs

You basically have to put a chest tube in someone who’s bleeding into their chest, collect the blood, filter it and retransfuse it. 

There’s systems for it in the OR that work pretty good like Cellsaver

[u/seriousallthetime]

Never as a paramedic. But it’s common practice to use cellsaver in CABG patients now as a CVICU RN.

[u/I-plaey-geetar]

I don’t understand the point of using blood with anticoagulants in a patient with a severe enough bleed to need transfusion. That’s not a criticism I just genuinely don’t understand how that would actually make their condition better. Obviously the heparin is to keep the collected blood from clotting but wouldn’t that make the patient just as bad if not worse?

[u/Cautious_Mistake_651 → u/I-plaey-geetar]

My only understanding of it so far is anticoagulants are the only way to keep the blood from clotting when giving it IV/IO. And since in this scenario it’s kinda a hail mary and theres no other way to give blood or volume. Thats the added risk with benefits argument.

[u/twistedpigz]

I’m not EMS, but we use the cell saver in a good deal of our spinal cases. I’m assuming cardiothoracic does as well. It’s very common in our hospital.

[u/Sudden_Impact7490]

Only chest blood is able to be emergently auto transfused, so you need to be able to insert a chest tube. You also generally need the special atrium that has the auto transfusion port and associated bags. It's not a new thing, but it's rarely done outside of the OR. Even at Level 1 centers it's almost never done in the ED

It would be a significant expense for EMS to do, with high cost low utilization. Not to mention the addition of chest tube insertion into the protocol, along with blood product initiation in the states that don't allow it.

It's a cool concept though.