Use of cell salvage in obstetrics in Germany: analysis of national database of 305 610 cases with peripartum haemorrhage

Vanessa Neef; Benjamin Friedrichson; Thomas Jasny; Oliver Old; Florian J Raimann; Suma Choorapoikayil; Andrea U Steinbicker; Patrick Meybohm; Kai Zacharowski; Jan Andreas Kloka

doi:10.1016/j.bja.2023.12.014

Use of cell salvage in obstetrics in Germany: analysis of national database of 305 610 cases with peripartum haemorrhage

Br J Anaesth. 2024 Jan 23:S0007-0912(23)00730-4. doi: 10.1016/j.bja.2023.12.014. Online ahead of print.

Affiliations

¹ Goethe University Frankfurt, University Hopsital, Department of Anaesthesiologie, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany. Electronic address: Neef@med.uni-frankfurt.de.
² Goethe University Frankfurt, University Hopsital, Department of Anaesthesiologie, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany.
³ University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.

PMID: 38267339
DOI: 10.1016/j.bja.2023.12.014

Abstract

Background: One of the leading causes of maternal death worldwide is severe obstetric haemorrhage after childbirth. Use of intraoperative cell salvage is strongly recommended by international guidelines on patient blood management. Recent data provide strong evidence that use of cell salvage in obstetrics is effective and safe in women with postpartum haemorrhage resulting in fewer transfusion-related adverse events and shorter hospital stay. We retrospectively analysed the use of cell salvage in bleeding women during delivery for a period of 10 yr in German hospitals.

Methods: Data from the German Federal Statistical Office were used that covers all in-hospital birth deliveries from 2011 to 2020. Prevalence of peripartum haemorrhage (pre-, intra-, and post-partum haemorrhage), comorbidities, peripartum complications, administration of blood products, and use of cell salvage were analysed.

Results: Of 6 356 046 deliveries in Germany, 305 610 women (4.8%) suffered from peripartum haemorrhage. Of all women with peripartum haemorrhage, postpartum haemorrhage was the main cause for major obstetric haemorrhage (92.33%). Cell salvage was used in only 228 (0.07%) of all women with peripartum haemorrhage (cell salvage group). In women undergoing Caesarean delivery with postpartum haemorrhage, cell salvage was used in only 216 out of 70 450 women (0.31%).

Conclusion: Cell salvage during peripartum haemorrhage is rarely used in Germany. There is tremendous potential for the increased use of cell salvage in peripartum haemorrhage nationwide.

Keywords: autologous blood; cell salvage; obstetrics; patient blood management; postpartum haemorrhage.