Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine

View all recommendations from this society

September 21, 2021

Avoid/reduce allogenic transfusion by first using cell salvage for pediatric high blood loss surgery.

Cell salvage, as a part of a multimodal patient blood management strategy in pediatrics, may reduce unnecessary blood transfusions, improve outcomes and decrease costs. Expert consensus recommendations, observational reports and prospective research suggest that utilizing cell salvage decreases RBC transfusions in infants, children and adolescents undergoing craniosynostosis, spinal and cardiac surgical procedures. While prospective clinical studies are few, the evidence suggests that cell salvage is feasible, effective, and safe. More high-quality trials will further guide optimum use.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely® campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient healthcare delivery and responsible use of resources.

A Task Force composed of specialists in neonatal and pediatric medicine and surgery was appointed at the suggestion of the SABM Educational Oversight Committee. With SABM BOD approval, this Task Force drafted an initial set of statements. Evidence-based recommendations were based on our Society’s foundational pillars and structured around published SABM Standards. For this particular list, the SABM Standards, Section 13, 5th edition for neonatal and pediatric patients were critical for statement development. An essential element was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were vetted by the Task Force. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The Educational Oversight Committee and the BOD approved the materials prior to submission to the Choosing Wisely® national team.

Working with this initiative, our selected recommendations and integrated materials will be further honed based on subsequent Campaign review. The list and supporting evidence, once approved, will form the basis of a manuscript for publication in a peer-reviewed journal. We foresee this as a vehicle for outreach to other professional societies, healthcare providers and patients.


Goobie SM, Gallagher T, Gross I, Shander A. Society for the advancement of blood management administrative and clinical standards for patient blood management
programs. 4th edition (pediatric version).Paediatr Anaesth. 2019 Mar;29(3):231-236

Faraoni D, Meier J, New HV, Van der Linden PJ, Hunt BJ. Patient Blood Management for Neonates and Children Undergoing Cardiac Surgery: 2019 NATA Guidelines.
J Cardiothorac Vasc Anesth. 2019 Dec;33(12):3249-3263

Patient Blood Management evidence based guidelines: Module 6 Neonatal and Paediatrics

Cholette JM, Powers KS, Alfieris GM, Angona R, Henrichs KF, Masel D, Swartz MF, Daugherty LE, Belmont K, Blumberg N. Transfusion of cell saver salvaged blood in
neonates and infants undergoing open heart surgery significantly reduces RBC and coagulant product transfusions and donor exposures: results of a prospective,
randomized, clinical trial. Pediatr Crit Care Med. 2013 Feb;14(2):137-47

Stone N, Sardana V, Missiuna P. Indications and Outcomes of Cell Saver in Adolescent Scoliosis Correction Surgery: A Systematic Review. Spine (Phila Pa 1976). 2017
Mar 15;42(6):E363-E370

Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Haas T, Jacob M, Lancé MD, Pitarch
JVL, Mallett S, Meier J, Molnar ZL, Rahe-Meyer N, Samama CM, Stensballe J, Van der Linden PJF, Wikkelsø AJ, Wouters P, Wyffels P, Zacharowski K. Management of
severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. Eur J Anaesthesiol. 2017 Jun; 34(6):332-395