Autotransfusion of blood contaminated by enteric contents: a potentially life-saving measure in the massively hemorrhaging trauma patient?

The role of autotransfusion of shed blood is well established in thoracic, abdominal, vascular, and orthopedic elective surgery. When hollow viscera or infected organs are uninvolved, autotransfusion is also well accepted in trauma surgery. Less clear is whether shed blood from an injury violating hollow organs in the abdomen can be used safely in the trauma patient. We retrospectively identified 11 patients with penetrating thoracoabdominal trauma who had received enteric contaminated shed blood, processed by the Haemonetics Cell Saver, and reviewed their records for infectious morbidity or mortality. All patients received parenteral broad-spectrum antibiotics. Three patients developed infectious wound complications, one probably nosocomial from the intensive care unit. No patient developed intra-abdominal sepsis and no deaths were reported. Based on the results of this preliminary result, it may be appropriate to use autotransfusion of shed blood in trauma patients with gastrointestinal injuries, if banked blood is not readily available and the patients receive perioperative broad-spectrum antibiotics.