Autologous salvaged blood, commonly called cell salvage, is an established perioperative blood conservation modality to mitigate the impact of acute blood loss by recapturing shed blood and reducing allogeneic transfusion exposures.^1,2 Cell salvage is endorsed as a key perioperative patient blood management strategy in expert guidelines and by numerous professional societies.^1–11 Cell salvage is most often utilized in high-blood-loss surgeries, such as cardiothoracic, vascular, and spine cases, where randomized trials have shown the technology to safely reduce the rate and volume of allogeneic transfusion. For example, in a meta-analysis of 82 randomized clinical trials with more than 12,500 participants across a variety of surgery types, cell salvage compared to no cell salvage significantly reduced the risk of allogeneic transfusion with a risk ratio of 0.65 (95% CI, 0.59 to 0.72) without evidence of differences in perioperative adverse events.¹² Despite this, implementation of cell salvage remains highly variable. In a study employing the National Inpatient Sample database and evaluating cell salvage utilization trends from 1995 through 2015, the rate of perioperative cell salvage utilization increased rapidly from 11.6 per 100,000 hospitalizations in 1995 to a peak of 205.1 per 100,000 hospitalizations in 2008 before declining to a rate of approximately 150 per 100,000 hospitalizations by 2015.¹³ While recent changes may be related, in part, to improvements in surgical technique and hemostasis management which reduce perioperative bleeding, utilization generally remains low and varies greatly by surgery type. For example, the highest utilization was observed in total hip and knee replacement surgeries (10.6% and 9.2% of hospitalizations, respectively, with at least 1 cell salvage transfusion) followed by cardiac surgery (e.g., 7.0% of aortic valve replacements and 2.5% coronary artery bypass surgeries) and spine surgery (e.g., 6.9% of lumbar fusions). Utilization is even lower in certain surgical populations, such as oncologic surgery, given theoretical concerns for tumor dissemination or other adverse effects. Part of this problem may stem from insufficient high-quality evidence in many surgery types, predominantly due to a lack of well-powered clinical trials or methodologic limitations in existing observational studies. Perhaps even more important, several myths are commonly encountered in clinical practice, which impede broader implementation. While several of these myths are addressed in existing professional guidelines, in general, their discussion remains superficial and has not swayed the concerns of practicing anesthesiologists, surgeons, and other perioperative clinicians. Here, we attempt to fill this critical gap by reviewing the evidence behind four key myths of perioperative cell salvage (fig. 1), which may impede broader cell salvage adoption.