Perioperative red cell, plasma, and blood volume change in patients undergoing cardiac surgery

Slight, Robert; Bappu, Norzeihan Jan; Nzewi, Onyekwelu; McClelland, D. B. L.; Mankad, Pankaj

doi:10.1111/j.1537-2995.2006.00734.x

Cited by 18 publications

(22 citation statements)

References 16 publications

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“…Other methods, such as calculating blood loss based on the changes in postoperative hemoglobin levels, are not recommended in cardiac surgical patients as a consequence of the high fluid loads infused during surgery and the resultant hemodilution. 38 For safety assessments, the amount of aprotinin or tranexamic acid in patients' blood was only measured in a limited number of patients in two studies. 17,21 Also, indirect measurement of systemic absorption of these medications and adverse effects have not been properly evaluated in the included trials.…”

Section: Discussionmentioning

confidence: 99%

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

Abrishami

Chung

Wong

2009

Can J Anesth/J Can Anesth

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Purpose This systematic review aimed to evaluate the efficacy and safety of topical application of antifibrinolytic drugs to reduce postoperative bleeding and transfusion requirements in patients undergoing on-pump cardiac surgery. Methods We searched The Cochrane Library, MED-LINE, EMBASE and SCI-EXPANDED for all randomized controlled trials on the topic. Trial inclusion, quality assessment, and data extraction were performed independently by two authors. Standard meta-analytic techniques were applied. Results Eight trials (n = 622 patients) met our inclusion criteria. The medication/placebo was applied into the pericardial cavity and/or mediastinum at the end of cardiac surgery. Seven trials compared antifibrinolytic agents (aprotinin or tranexamic acid) versus placebo. They showed that, on average, topical use of antifibrinolytic agents reduced the amount of 24-h postoperative chest tube (blood) loss by 220 ml (95% confidence interval: -318 to -126, P \ 0.00001, I 2 = 93%) and resulted in a saving of 1 unit of allogeneic red blood cells per patient (95% confidence interval: -1.54 to -0.53, P \ 0.0001, I 2 = 55%). The incidence of blood transfusion was not significantly changed following topical application of the medications. One study comparing topical versus intravenous administration of aprotinin found comparable results between the two methods of administration for the abovementioned outcomes. No adverse effects were reported following topical use of the medications. Conclusion This review suggests that topical application of antifibrinolytics can reduce postoperative bleeding and transfusion requirements in patients undergoing on-pump cardiac surgery. These promising findings need to be confirmed by more trials with large sample size using patient-related outcomes and more assessments regarding the systemic absorption of the medications. RésuméObjectif Le but de cette e´tude me´thodique e´tait d'e´valuer l'efficacite´et l'innocuite´de l'application topique d'agents anti-fibrinolytiques afin de re´duire les saignements et les besoins transfusionnels postope´ratoires chez les patients subissant une chirurgie cardiaque avec circulation extracorporelle. Méthode Nous avons fouille´les bases de donne´es suivantes afin d'extraire toutes les e´tudes randomise´es contrôle´es traitant de cette question : The Cochrane Library, MEDLINE, EMBASE et SCI-EXPANDED. L'inclusion des e´tudes, l'e´valuation de la qualite´et l'extraction des donne´es ont e´te´re´alise´es de façon inde´-pendante par deux auteurs. Des techniques de me´ta-analyse standard ont e´te´utilise´es. Résultats Huit e´tudes (n = 622 patients) ont satisfait aǹ os crite`res d'inclusion. Le me´dicament/placebo a e´teá pplique´dans la cavite´pe´ricardique et/ou dans le me´dia-stin a`la fin de la chirurgie cardiaque. Sept e´tudes ont compare´des agents anti-fibrinolytiques (aprotinine ou acide tranexamique) a`un placebo. Ces e´tudes ont montre´que, en moyenne, l'application topique d'agents

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Section: Discussionmentioning

confidence: 99%

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

Abrishami

Chung

Wong

2009

Can J Anesth/J Can Anesth

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“…Such haemodilution has a major effect on haemoglobin (Hb) concentration. As a consequence patients may be transfused red blood cells (RBC) despite the loss of little red cell volume (RCV) [3,4]. There is currently no convenient and repeatable method for determining RCV.…”

Section: Introductionmentioning

confidence: 99%

Rationalizing blood transfusion in cardiac surgery: preliminary findings with a red cell volume‐based model

et al. 2006

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“…A more useful parameter for evaluating real blood loss and assessing transfusion needs could be RBC mass. 27 However, this is difficult to calculate, since the use of standard formulae is subject to bias. There is no simple method for measuring RBC mass in clinical practice, and it is hard to estimate real blood volume due to administration of fluids and leakage into the interstitial space.…”

Section: Discussionmentioning

confidence: 99%

Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial

Rodríguez

Hernández

Bárcenas

et al. 2015

Revista Española de Anestesiología y Reanimación (English Editi

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Perioperative red cell, plasma, and blood volume change in patients undergoing cardiac surgery

Abstract: PV and BV expansion are significant factors that may lead to a Hb value that is misleadingly low in that it overestimates the decrease in RCV. This effect could lead to unnecessary transfusion if the RBC transfusion threshold is based only on Hb concentration.

Cited by 18 publications

References 16 publications

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

Rationalizing blood transfusion in cardiac surgery: preliminary findings with a red cell volume‐based model

Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial

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