Partly intraoperative cell salvage in pediatric craniocerebral trauma: effects on coagulation function, allogeneic blood requirements, and clinical outcomes - a propensity score-matched retrospective cohort study.

BACKGROUND

Traumatic brain injury (TBI) in children frequently necessitates intraoperative blood transfusion owing to the hemorrhagic risk associated with hematoma evacuation. Intraoperative cell salvage (ICS) offers a strategy to reduce allogeneic blood exposure. However, the impact of partial usage of ICS on coagulation function in the pediatric neurosurgical setting remains insufficiently characterized.

METHODS

This retrospective cohort study enrolled 136 children (aged 1-18 years) who underwent cerebral hematoma evacuation between February 2016 and April 2022. Patients receiving combined autologous and allogeneic transfusion constituted the ICS group (n = 42), while those receiving allogeneic transfusion alone constituted the ABL group (n = 94). Propensity score matching (PSM) at a 1:1 ratio yielded 41 matched pairs. Perioperative coagulation indices (PT, APTT, INR, FIB, PLT), serum electrolytes, hemoglobin (Hb), hematocrit (Hct), and clinical outcomes were compared between groups before and after PSM.

RESULTS

Following PSM, allogeneic blood consumption was significantly higher in the ABL group (P < 0.001), while total red cell volume did not differ. No significant intergroup differences were detected in postoperative PT, APTT, INR, PLT, Hb, Hct, or serum electrolytes (all P > 0.05). The composite coagulation disorder rate was significantly lower in the ICS group both before PSM (19.0% vs. 44.7%; P = 0.008) and after PSM (17.1% vs. 39.0%; P = 0.049). Hypofibrinogenemia (FIB < 1.5 g/L) was significantly less frequent in the ICS group before and after PSM (P = 0.014 and P = 0.040, respectively). Clinical outcomes including operating time, ICU admission, intubation duration, and hospital stay did not differ significantly after PSM.

CONCLUSION

Partial intraoperative autologous blood salvage in pediatric hematoma evacuation reduces allogeneic blood consumption and the incidence of postoperative coagulation disorders without impairing standard coagulation indices or electrolyte balance. These findings are hypothesis-generating and require confirmation in prospective multicenter trials.