LAUSR

The Association of Anaesthetists 2018 guidelines: ‘cell salvage for peri-operative blood conservation’ makes three statements regarding the use of intra-operative cell salvage in caesarean section [1]: ‘Current evidence does not support the routine use of cell salvage during caesarean section’, ‘Therefore, the Working Party recommends that caesarean section is not used routinely for caesarean section based on the current evidence, be it elective, urgent or emergency’ and ‘Cell salvage should be considered in “collect only” mode in patients who are anaemic before surgery or if there is unanticipated ongoing bleeding during surgery’. The first of these is a fair interpretation of the results of a recent study (SALVO) [2], which we think was a pragmatic randomised controlled trial. However, we would be cautious in extrapolating these findings to the recommendation that intra-operative cell salvage should not be routinely used during caesarean section. We have recently instituted a quality improvement programme that has established the routine use of intraoperative cell salvage for caesarean section and other surgeries at our hospital. We would like to invite the Working Party to reply to our following comments: