Protocol guided bleeding management improves cardiac surgery patient outcomes

Abstract

The implementation of a bleeding management protocol supported by POCCT in a cardiac surgery programme was associated with significant reductions in the transfusion of allogeneic blood products, improved outcomes and reduced cost.

Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient's Outcome

“…28,29 Our results indicate that most of the proposed PBM measures were consistently implemented in all four centers, in particular the presence of a multidisciplinary PBM core team, regular education sessions, use of a PBM checklist, autologous red cell recovery, emphasis on hemostasis, hemotherapy algorithm, and standardization of transfusion practice. But still most of the selected PBM measures have been shown to reduce RBC utilization in surgical patients such as autologous red cell recovery, 31 reducing blood collection tubes, 32 pointof-care diagnostic in coagulopathy, 33 hemotherapy algorithm, 34 and standardization of transfusion practice using checklists. Possible reasons might be high personal and financial resources and expertise to implement anemia screening and treatment.…”

Successful treatment of bleeding with tranexamic acid in a series of 12 patients with immune thrombocytopenia

“…Tranexamic acid (TA), an antifibrinolytic lysine analogous, has been shown to reduce bleeding in many surgical and medical settings including trauma, cardiovascular operations, orthopaedic arthroplasty, liver transplantation and menorrhagia . From our own experience and of others (personal communication), TA has been frequently used in the management of patients with refractory ITP since several decades.…”

Overcoming barriers to evidence-based patient blood management: a restricted review

“…Fourteen papers were selected for final inclusion (see Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Study designs included before and after implementation studies (n = 3) [10, 20, 23], retrospective observational (n = 6) [11-13, 16, 18, 21] and prospective interventional studies (n = 5) [14,15,17,19,22].…”

“…Study designs included before and after implementation studies (n = 3) [10, 20, 23], retrospective observational (n = 6) [11-13, 16, 18, 21] and prospective interventional studies (n = 5) [14,15,17,19,22]. The majority of studies were conducted in Europe (n = 5) [13,17,19,20,22] or North America (n = 8 )[10-12, 14-16, 18, 23] with one paper from Australia [21]. Half of the included papers studied perioperative patient populations (50%, n = 7) [10,11,13,15,19,21,41], while 7% (n = 1) were focused on critical care [23], and 43% (n = 6) were unspecified [12,14,[16][17][18]20].…”

“…Many implementation strategies that support the implementation of PBM guidelines have been developed and utilised, but it is not clear which are the most effective [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Some examples of implementation strategies used to improve the uptake of PBM guidelines include using local consensus processes, audit and feedback, providing education and identifying and preparing champions [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. A systematic review by Tinmouth and colleagues found the use of behavioural implementation strategies to be effective at reducing blood product utilisation, but due to heterogeneity across studies, they could not make specific recommendations [25].…”