Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital

Yao, Yun-Tai; Yuan, Xin; He, Li-Xian; Yu, Yiping; Du, Yu; Liu, Gang; Tian, Lijuan; Ma, Zeliang; Zhang, Yongbao; Ma, Jie

doi:10.24920/004035

Cited by 5 publications

(6 citation statements)

References 44 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 64 ] The reported incidence of postoperative seizure at Fuwai Hospital was between 0.7% and 1.1%. [ 65 ] It is noteworthy that the diagnosis of TXA-induced seizure of previous studies was often made clinically without electroencephalogram confirmation. Currently, there is an ongoing large-scale TXA RCT (NCT03782350) [ 66 ] at Fuwai Hospital, which utilized electroencephalogram monitoring to assess the effects of TXA dose on the occurrence of postoperative seizure.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

Lin¹,

Yao²,

Tian³

et al. 2023

Medicine

Self Cite

View full text Add to dashboard Cite

Background: The current study was performed to systemically review the efficacy and safety of tranexamic acid (TXA) in patients undergoing cardiac surgery at a single large-volume cardiovascular center.Methods: A computerized search of electronic databases was performed to identify all relevant studies using search terms till December 31 st , 2021. The primary outcomes were postoperative blood loss and the composite incidence of mortality and morbidities during hospitalization. Secondary outcomes included postoperative massive bleeding and transfusion, postoperative recovery profiles, coagulation functions, inflammatory variables, and biomarkers of vital organ injury.Results: Database search yielded 23 qualified studies including 27,729 patients in total. Among them, 14,136 were allocated into TXA group and 13,593 into Control group. The current study indicated that intravenous TXA significantly reduced total volume of postoperative bleeding in both adult and pediatric patients, and that medium-and high-dose TXA were more effective than low-dose TXA in adult patients (P < .05). The current study also demonstrated that intravenous TXA, as compared to Control, remarkably reduced postoperative transfusion incidences and volume of red blood cell and fresh frozen plasma, and reduced postoperative transfusion incidence of platelet concentrates (PC) (P < .05) without obvious dose-effects (P > .05), but TXA did not reduce PC transfusion volume postoperatively in adult patients (P > .05). For pediatrics, TXA did not significantly reduce postoperative transfusion incidence and volume of allogenic red blood cell, fresh frozen plasma and PC (P > .05). Additionally, the current study demonstrated that intravenous TXA did not influence the composite incidence of postoperative mortality and morbidities in either adults or pediatrics during hospitalization (P > .05), and that there was no obvious dose-effect of TXA in adult patients (P > .05).Conclusions: This current study suggested that intravenous TXA significantly reduced total volume of postoperative bleeding in both adult and pediatric patients undergoing cardiac surgery at the single cardiovascular center without increasing the composite incidence of mortality and morbidities.Abbreviations: CABG = coronary artery bypass graft, CPB = cardiopulmonary bypass, cTn = cardiac troponin, DAPT = dual antiplatelet therapy, FFP = fresh frozen plasma, IL = Interleukin, INR = international normalized ratio, LOS = length of stay, PC = Platelet concentrates, Plt = platelet, PMNE = polymorphonuclear neutrophil elastase, PT = prothrombin time, RBC = red blood cell, RCT = randomized controlled trial, SAPT = single antiplatelet therapy, TXA = tranexamic acid, WBC = white blood cell.

show abstract

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

Lin¹,

Yao²,

Tian³

et al. 2023

Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Sufentanil 1 µg/kg was added before CPB, during CPB inhalation anesthesia was stopped and intravenous anesthesia was maintained, and Sufentanil 1 µg/kg was added again after rewarming. Adequate anesthesia depth was achieved by maintaining the bispectral index (BIS) values between 40 and 60 intraoperatively ( 8 ).…”

Section: Methodsmentioning

confidence: 99%

Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis

Qi¹,

Yu²,

Yang³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundMyxomas are the most common primary cardiac tumors. Intracardiac myxomas, although benign, could cause serious consequences such as tricuspid or mitral valve obstruction, hemodynamic collapse, and acute heart failure, which pose challenges during anesthetic management. The current study was designed to summarize the anesthetic management of patients undergoing cardiac myxoma resection.MethodsThis study was performed retrospectively from the perioperative period of patients who underwent myxoma resection. Patients were divided into two groups according to whether the myxoma prolapsed into the ventricle (group O) or not (group N) to evaluate the impact of tricuspid or mitral valve with obstruction.Results110 patients, aged 17–78 years, undergoing cardiac myxoma resection between January 2019 and December 2021 were collected, and their perioperative characteristics were recorded. In the preoperative evaluation, common clinical symptoms included dyspnea and palpitation, whereas embolic events occurred in 8 patients, including 5 (4.5%) cerebral thromboembolic events, 2 (1.8%) femoral artery, and 1 (0.9%) obstructive coronary artery. According to the echocardiography, left atrial myxoma was detected in 104 (94.5%) patients, the average dimension of myxoma was 4.03 cm ± 1.52 cm in the largest diameter, and 48 patients were divided into group O. During intraoperative anesthetic management, hemodynamic instability occurred in 38 (34.5%) patients after anesthesia induction. More patients in group O had hemodynamic instability (47.9% vs. 24.2%, p = 0.009) than in group N. The mean postoperative length of stay in the hospital was 10.64 ± 3.01 days, and most of the patients made an uneventful postoperative recovery.ConclusionsAnesthetic management for myxoma resection can be composed by assessing the myxoma, particularly the echocardiography evaluation and preventing cardiovascular instability. Typically, tricuspid or mitral valve with obstruction is a premier ingredient in anesthetic management.

show abstract

“…After intubation, both groups received an 8.5 Fr three-lumen central venous catheter and an 8.5 Fr Swan-Ganz catheter through the right internal jugular vein. Blood transfusion is strictly supervised and follows the indication of blood transfusion published by our centre 14. Standardised intraoperative blood conservation techniques, cell salvage and pump suction will be used in both groups.…”

Section: Methods and Analysismentioning

confidence: 99%

Efficacy of autologous plateletpheresis in adult aortic surgery: study protocol for a randomised controlled trial

et al. 2023

View full text Add to dashboard Cite

IntroductionPerioperative coagulopathy is common in patients undergoing aortic surgery, increasing the risk of excessive blood loss and subsequent allogeneic transfusion. Blood conservation has become a vital part of cardiovascular surgery, but measures to protect platelets from destruction by cardiopulmonary bypass (CPB) are still lacking. Autologous platelet concentrate (APC) may have potential benefits for intraoperative blood preservation, but its efficacy has not been studied extensively. This study aims to evaluate the efficacy of APC as a blood conservation technique to reduce blood transfusion in adult aortic surgery.Methods and analysisThis is a prospective, single-centre, single-blind randomised controlled trial. A total of 344 adult patients undergoing aortic surgery with CPB will be enrolled and randomised to either the APC group or the control group with a 1:1 randomisation ratio. Patients in the APC group will receive autologous plateletpheresis before heparinisation, while those in the control group will not. The primary outcome is the perioperative packed red blood cell (pRBC) transfusion rate. Secondary endpoints include the volume of perioperative pRBC transfusion; drainage volume within 72 hours post-surgery; postoperative coagulation and platelet function; and the incidence of adverse events. Data will be analysed according to the intention-to-treat principle.Ethics and disseminationThis study was approved by the institutional review board of Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (no. 2022-1806). All procedures included in this study will be performed in adherence to the Helsinki Declaration. The results of the trial will be published in an international peer-reviewed journal.Trial registration numberChinese Clinical Trial Register (ChiCTR2200065834).

show abstract

Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital

Cited by 5 publications

References 44 publications

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis

Efficacy of autologous plateletpheresis in adult aortic surgery: study protocol for a randomised controlled trial

Contact Info

Product

Resources

About