Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
BMJ Open. 2022 May 16;12(5):e056018. doi: 10.1136/bmjopen-2021-056018.
Globally, haemorrhage is the leading cause of both maternal mortality and preventable trauma death. For patients suffering from haemorrhage, prompt blood transfusion can be life-saving; however, safe and sufficient blood is often lacking in low-resource settings (LRS). Autotransfusion (AT), in which the patient's own blood is collected and transfused back, is an established alternative to donor blood transfusions, although one that is primarily performed with advanced AT systems. Research on basic AT in LRS is scarce. Therefore, we aimed to consolidate all available information on the current use of basic AT in LRS and to identify AT techniques and devices described for use in such settings.
Scoping review.
We systematically searched four key databases: PubMed, Web of Science, Global Health and Cochrane Library as well as several grey literature databases and databases of relevant organisations. The final search was conducted on 22 April 2019. We included all types of studies referring to any information on basic AT used or sought to be used in LRS, published in English and dated after 31 December 2008. We synthesised the data from the included studies, results were charted or summarised narratively.
Some 370 records were reviewed, yielding 38 included documents. We found a paucity of scientific evidence as well as contradictory information on the extent of AT use and that AT use is largely undocumented. The most commonly described indications were haemoperitoneum (primarily among obstetric patients) and haemothorax. We identified three AT techniques used in LRS. Additionally, two new devices and one filter are described for potential use in LRS.
Basic AT is practiced for certain obstetric and trauma indications. However, context-specific studies are needed to determine the technique's safety and effectiveness. Extent of use is difficult to assess, but our results indicate that basic AT is not a widely established practice in LRS. Future research should address the bottlenecks hampering basic AT availability. New AT devices for use in LRS are described, but their utility and cost-effectiveness remain to be assessed.
在全球范围内，出血是孕产妇死亡和可预防创伤死亡的主要原因。对于出血的患者，及时输血可能是救命的；然而，在资源匮乏的环境中（LRS），往往缺乏安全且充足的血液。自身输血（AT）是一种将患者自身的血液采集并回输的替代供体血液输血的方法，尽管它主要是通过先进的 AT 系统来实现的。在 LRS 中对基本 AT 的研究很少。因此，我们旨在汇总所有关于 LRS 中基本 AT 当前使用情况的可用信息，并确定在这些环境中描述的 AT 技术和设备。
范围综述。
我们系统地搜索了四个主要数据库：PubMed、Web of Science、全球卫生和 Cochrane 图书馆以及几个灰色文献数据库和相关组织的数据库。最后一次搜索是在 2019 年 4 月 22 日进行的。我们纳入了所有类型的研究，这些研究涉及到在 LRS 中使用或寻求使用的基本 AT 的任何信息，发表于 2008 年 12 月 31 日之后的英文文献。我们对纳入研究的数据进行了综合，结果以图表或叙述性总结的形式呈现。
共审查了 370 份记录，纳入了 38 份文件。我们发现，关于 AT 使用的范围和使用情况的科学证据很少，而且存在矛盾的信息。最常描述的适应症是血腹（主要是在产科患者中）和血胸。我们确定了在 LRS 中使用的三种 AT 技术。此外，还描述了两种新设备和一种用于潜在使用的过滤器。
基本 AT 用于某些产科和创伤适应症。然而，需要进行特定于背景的研究以确定该技术的安全性和有效性。使用范围难以评估，但我们的结果表明，基本 AT 在 LRS 中不是广泛建立的实践。未来的研究应解决阻碍基本 AT 供应的瓶颈。描述了用于 LRS 的新 AT 设备，但它们的实用性和成本效益仍有待评估。
