Intraoperative Blood Salvage in Bacterial Contaminated Surgical Site an in vitro Study

Background: Cell saving and autogenic retransfusion is a well established procedure in orthopedic, cardiac and abdominal surgery. But it is contraindicated at a bacterially contaminated surgical site such as the oral cavity. Materials and Methods: In 2003 and 2004 a clinically oriented in vitro study was processed in 45 enlarged operations for dysgnathia to recycle the intraoperatively collected blood contaminated with microrganisms of the oral cavity. Cell salvage, leukocyte depletion, antimicrobial medical treatment, and a selective endotoxin adsorption were used as single cleaning procedures. Hematological, coagulative, immunologic and microbiological examinations were carried out, including the measurement of endotoxin before, during and after the procedure. In addition, the individual cleaning steps were changed in their succession to determine the most effective one. Results: Already cell salvage and leukocyte depletion could eliminate a considerable part of the oral cavity germs. However, only extracorporeal addition of antibiotic and antimycotic agents guaranteed a reproducible bacterial removal. Endotoxin could be eliminated up to 99.9 ± 0.1% by all purification steps, including a specific endotoxin adsorber. At the end of all procedures hematocrit was increased by a renewed washing centrifugation. The hemolysis rate at the end was 0.2 ± 0.1%. Cytokines and fibrin degradation products were eliminated by more than 90%. Because of the multistage purification procedure, 50% of intraoperative blood loss could be compensated. Conclusion: The combination of cell salvage, leukocyte depletion, antimicrobial medical treatment and selective endotoxin adsorption allows for the production of autogenic red blood cell concentrates free of germs, saliva and endotoxin also from a bacterially contaminated surgical site. Schlüsselwörter Intraoperative Autotransfusion · Maschinelle Autotransfusion · Orthognathe Chirurgie · Blutverlust · Bakterielle Elimination · Endotoxinadsorption