Intraoperative autotransfusion: an underutilized technique.

Although interest in intraoperative autotransfusion increased when commercial equipment became available, this technique still is utilized rarely in most hospitals. Our experience began with sporadic use in 1972 and has evolved to regular use at least ten times a month. The machine is operated by a technician, and we heparinize the autotransfusion system (ATS) reservoir. Our series includes 47 patients who had elective vascular operations and 141 who had emergency operations, usually for trauma. In the latter group, seven patients who were autotransfused with blood contaminated by intestinal contents survived near fatal injuries and did not develop complications attributable to the procedure. Morbidity and mortality rates in both groups did not appear to be increased as a result of intraoperative autotransfusion. Controversy over methods of anticoagulation and apprehension about effect on blood are not valid reasons for underutilization of this technique. Although significant administrative commitments are required to implement its use and to treat the coagulopathy that accompanies massive reinfusions, they are justified by the value of intraoperative autotransfusion in most cases in which two or more units of blood would be required ordinarily.