Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

One out of 3 specialist commentators was familiar with this technology.

Level of innovation

The specialist commentators all agreed that Hemosep is a variation on existing cell salvage technology; 1 felt that this was a minor variation and another thought that it was somewhat novel.

Potential patient impact

One commentator felt that by reducing the need for allogenic blood transfusions, Hemosep could reduce risks such as potential blood mismatch and transmission of viral infections. They suggested that Hemosep could be useful for patients who are expected to lose over 20% of their blood volume, such as those having cardiac surgery, or after major trauma or major obstetric haemorrhage. However, another commentator stated there could be problems when using Hemosep for high blood loss surgery or uncontrolled haemorrhage because of the possibility of reinfusing activated white blood cells and platelets. They suggested that more research is needed in this area. The same commentator felt that Hemosep could be particularly useful in low to moderate blood loss surgeries such as routine open heart surgery, hip replacements and elective aortic surgery.

Potential system impact

All commentators agreed that Hemosep might reduce the need for allogenic blood transfusions, which could lead to shorter hospital stays and reduce the need for donor blood. Implementing Hemosep would need few infrastructural changes but all commentators felt that it could result in savings to the NHS. Two of the commentators felt that it may be difficult to encourage use of Hemosep because it is competing with bagging of the pump blood, which is very cheap and effective, and with cell salvage devices that are already used in most centres. One commentator noted that NICE's estimate of the costs of cell salvage was inflated and may not have taken into account high-use centres.

All commentators agreed that minimal training would be needed. One stated that the availability of staff trained in cell salvage can sometimes be a problem, so having a device like Hemosep that is easy to use and does not need any specialist training would be beneficial.

General comments

One commentator felt that there was a need for additional research using this device in high blood loss surgery, uncontrolled haemorrhage or in patients in intensive care. This research should focus on inflammatory markers after reinfusion of the concentrated blood to look at frequency of complications. Studies should investigate the possible risk of reinfusing activated white blood cells and platelets into these groups, which can lead to pulmonary dysfunction and disseminated intravascular coagulopathy.

One commentator stated that there could be time constraints associated with Hemosep. The manufacturer recommends allowing 40 minutes to ultrafilter the blood, but this could cause problems if the patient needs blood volume very quickly, which happens often. The commentator noted that volume can be achieved very quickly through bagging of the pump blood or using a cell saver, which they felt made Hemosep a less attractive option in this scenario.