Effects of a targeted blood management programme on allogeneic blood transfusion in abdominal aortic aneurysm surgery

Stoneham, Mark D.; Kier, S von; Harvey, Laura; Murphy, Michael

doi:10.1111/tme.12495

Cited by 5 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22,23 Our results also reinforce the unexpected maintenance of coagulation in patients with massive blood loss, which we reported in our previous paper. 6 This contradicts current guidelines for the management of patients experiencing massive blood loss. None of our patients developed significant coagulopathy or hyperfibrinolysis as measured by TEG.…”

Section: Discussionmentioning

confidence: 97%

“…Intraoperative cell salvage (ICS) has been an established technique for >40 years to minimise blood loss and reduce allogeneic blood transfusion as part of PBM in patients undergoing major surgery 3–5 . We previously described the effective use of specialised ICS techniques as part of our PBM strategy to reduce allogeneic transfusion in 171 consecutive patients undergoing AAA surgery including the use of specialist PBM practitioners 6 . Out of those 171 patients, seven lost >70% of their estimated blood volume but none of those seven developed thromboelastographic (TEG) coagulation changes sufficient to require intraoperative intervention with any allogeneic blood components.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss

et al. 2022

Self Cite

View full text Add to dashboard Cite

Summary The loss of 50% blood volume is one accepted definition of massive haemorrhage, which ordinarily would trigger the massive transfusion protocol, involving the administration of high ratios of fresh frozen plasma and platelets to allogeneic red cells. We investigated 53 patients who experienced >50% blood loss during open elective abdominal aortic aneurysm surgery to assess allogeneic blood component usage and coagulopathy. Specialist patient blood management practitioners used a tailored cell salvage technique including swab wash to maximise blood return. We assessed the proportion of patients who did not require allogeneic blood components and develop evidence of coagulopathy by thromboelastography (TEG) parameters. Blood loss was 50%–174% (mean [SD] 68% [27%]) of blood volume. The mean (SD) intraoperative decrease in haemoglobin concentration, assessed by arterial blood gas analysis, was 5 (13) g/l. No patient received allogeneic red cells intraoperatively. Four of the 53 (8%) patients received blood components in the first 24 h postoperatively at the anaesthetists’ discretion. No patient had intraoperative TEG changes indicative of fibrinolysis or coagulopathy. The 30‐day mortality was 2% (one of 53). Reduction of allogeneic transfusion is one aim of patient blood management techniques. We have demonstrated virtual avoidance of allogeneic blood product transfusion despite massive blood loss. These data show possible alternatives to the current massive transfusion protocols to the management of elective vascular surgical patients.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a prospective study evaluating aneurysm surgery, VET parameters never reached a preset threshold for intervention. 60 In a smaller study in cardiac surgery, patients with large-volume autologous blood transfusions had a paradoxical procoagulant effect when evaluated by VET. 61 More research is needed in this area to explore the use of VET in liver transplants where blood salvage is used, as cirrhotic patients have markedly different coagulation profiles compared with patients with vascular disease.…”

Section: Cell Salvage Utilization During Noncoagulopathic Bleedingmentioning

confidence: 99%

Viscoelastic Management of Coagulopathy during the Perioperative Period of Liver Transplantation

Stewart

Nydam

Hendrickse

et al. 2022

Semin Thromb Hemost

View full text Add to dashboard Cite

Viscoelastic testing (VET) in liver transplantation (LT) has been used since its origin, in combination with standard laboratory testing (SLT). There are only a few, small, randomized controlled trials that demonstrated a reduction in transfusion rates using VET to guide coagulation management. Retrospective analyses contrasting VET to SLT have demonstrated mixed results, with a recent concern for overtreatment and the increase in postoperative thrombotic events. An oversight of many studies evaluating VET in LT is a single protocol that does not address the different phases of surgery, in addition to pre- and postoperative management. Furthermore, the coagulation spectrum of patients entering and exiting the operating room is diverse, as these patients can have varying anatomic and physiologic risk factors for thrombosis. A single transfusion strategy for all is short sighted. VET in combination with SLT creates the opportunity for personalized resuscitation in surgery which can address the many challenges in LT where patients are at a paradoxical risk for both life-threatening bleeding and clotting. With emerging data on the role of rebalanced coagulation in cirrhosis and hypercoagulability following LT, there are numerous potential roles in VET management of LT that have been unaddressed.

show abstract

“…Shander et al43 demonstrated that the total cost per unit of fresh frozen plasma transfused was $409 and $1608 per patient transfused. Although such costly elements, inappropriate and avoidable transfusion contributes significantly to health care budgets 40,44,45. Implementation of PBM initiatives to guide bleeding/coagulation management and to manage anemia has resulted in significant cost saving and improved patient outcomes 23,46-49…”

Section: Transfusion Is Not a Benign Therapymentioning

confidence: 99%

Patient Blood Management as an Emerging Concept in Quality

Ozawa,

Ozawa-Morriello,

Rock

et al. 2023

Journal of Nursing Care Quality

View full text Add to dashboard Cite

Background: Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable. Problem: Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs. Approach: Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making. Conclusions: PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.

show abstract

Effects of a targeted blood management programme on allogeneic blood transfusion in abdominal aortic aneurysm surgery

Cited by 5 publications

References 29 publications

Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss

Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss

Viscoelastic Management of Coagulopathy during the Perioperative Period of Liver Transplantation

Patient Blood Management as an Emerging Concept in Quality

Contact Info

Product

Resources

About