Blood Conservation in Cardiac Surgery

Anderson, L. E.

doi:10.1177/175045891002001203

Journal of Perioperative Practice

2010

DOI: 10.1177/175045891002001203

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Blood Conservation in Cardiac Surgery

L. E. Anderson

Abstract: Cardiac surgery is one of the largest users of blood and blood products--currently estimated at 15% of U.K. blood stocks. While the blood supply could be considered to be the safest it has ever been, there are well recognised risks associated with the transfusion of red cells and blood products. It is appropriate that attempts should be made to decrease and optimise the transfusion of blood and blood products.

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2012

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Decreasing the Need for Transfusion: Infant Cardiac Surgery Using Hemodilution and Recombinant Factor VIIa

et al. 2012

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Many strategies, including intraoperative acute normovolemic hemodilution (ANH) and pharmacologic agents, exist to minimize the use of allogeneic blood products in pediatric congenital heart surgery. Recombinant activated factor VIIa (rFVIIa) is a hemostatic agent approved for the treatment of bleeding episodes and prevention of bleeding in surgical interventions in patients with hemophilia A or B with inhibitors, acquired hemophilia, or congenital factor VII deficiency. Off-label use in nonhemophilic patients for uncontrolled hemorrhage is increasing although still under investigation. We present our experience with ANH and rFVIIa in nine patients. All were <16 months of age and underwent complex cardiac surgery with the end point of achieving hemostasis while decreasing or eliminating the need for allogeneic blood products. Clinically, we have observed rapid hemostasis in patients who underwent ANH and then had autologous blood reinfused after cardiopulmonary bypass, along with rFVIIa, without any time delay. The patients required no allogeneic blood products and therefore results suggested the potential utility of this practice. The study group consisted of nine patients <16 months of age who received rFVIIa in the operating room after open-heart surgery. Amount of autologous blood removed preoperatively, blood product use, time from protamine to rFVIIa administration, platelet count, INR, and fibrinogen level were retrospectively obtained. Of the nine patients, the three who underwent the most aggressive hemodilution received rFVIIa most rapidly and required no allogeneic blood products to achieve hemostasis although they had an average lower fibrinogen level on admission to the cardiothoracic intensive care unit. These preliminary data suggest that hemodilution before surgical stimulation and the rapid administration of rFVIIa, along with the reintroduction of autologous blood, may decrease or potentially eliminate the need for allogeneic blood products. Prospective trials are warranted to further explore this technique.

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Decreasing the Need for Transfusion: Infant Cardiac Surgery Using Hemodilution and Recombinant Factor VIIa

et al. 2012

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Blood Conservation in Cardiac Surgery

Cited by 1 publication

References 24 publications

Decreasing the Need for Transfusion: Infant Cardiac Surgery Using Hemodilution and Recombinant Factor VIIa

Decreasing the Need for Transfusion: Infant Cardiac Surgery Using Hemodilution and Recombinant Factor VIIa

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