Quality Management of a Comprehensive Blood Conservation Program During Cardiopulmonary Bypass

Zhang, Qiaoni; Zhao, Wei; Gao, Shijun; Yan, Shujie; Diao, Xiaolin; Wang, Yuefu; Xu, Xiaowei; Tian, Yu; Ji, Bingyang

doi:10.1016/j.athoracsur.2021.07.069

Cited by 10 publications

(15 citation statements)

References 19 publications

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“…The detailed protocols of these techniques are provided in our previous article. 9 Antifibrinolytic agent, tranexamic acid, was used routinely to reduce blood loss and transfusion during the operation.…”

Section: Methodsmentioning

confidence: 99%

Dose-dependent influence of red blood cell transfusion volume on adverse outcomes in cardiac surgery

et al. 2022

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Introduction Red blood cell (RBC) transfusion is associated with adverse outcomes, but there are few studies on the RBC volume. This study aimed to evaluate the relationship between intraoperative RBC volume and postoperative adverse outcomes for on-pump cardiac surgery. Methods Adult patients undergoing on-pump cardiac surgery from 1 January 2017 to 31 December 2018 were included. Those transfused with more than 6 units of RBC were excluded. The clinical characteristics of four groups with various RBC volume were compared. We analyzed the relationship between RBC volume and adverse outcomes through multivariable logistic regression. Results 12,143 patients were analyzed, of which 3353 (27.6%) were transfused with 1–6U RBC intraoperatively. The incidence of death, overall morbidity, acute kidney injury and prolonged mechanical ventilation were increased stepwise along with incremental RBC volume. After adjusting for possible confounders, patients transfused with 1–2U were associated with a 1.42-fold risk of death (99% CI, 1.21–2.34, p = 0.01) compared with patients without RBC, patients with 3–4U were associated with a 1.57-fold risk (99% CI, 1.32–2.80, p = 0.005) and patients with 5–6U had a 2.26-fold risk of death (99% CI, 1.65–3.88, p < 0.001). Similarly, the incidence of overall morbidity, acute kidney injury and prolonged mechanical ventilation increased several folds as the RBC numbers increased. Conclusions There was a significant dose-dependent influence of incremental intraoperative RBC volume on increased risk of adverse outcomes for on-pump cardiac surgery patients. Patient blood management practice should aim to reduce not only transfusion rate but also the volume of blood use.

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Section: Methodsmentioning

confidence: 99%

Dose-dependent influence of red blood cell transfusion volume on adverse outcomes in cardiac surgery

et al. 2022

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“…[43][44][45] Recent evidence, however, has shown that hemoglobin thresholds for increased risk may vary between men and women and between younger and older patients. [45][46][47][48][49] Combined with evidence suggesting RBC transfusion may not eliminate the risk of organ dysfunction and is associated with impaired outcomes, transfusion best practices remain elusive. 2,43,50,51 Contributing to uncertainty, 2 large randomized controlled trials in cardiac surgery did not show an impaired outcome with a more liberal transfusion strategy compared to a restrictive regimen.…”

Section: Updates On Transfusion Studies In Cardiac Surgerymentioning

confidence: 99%

“…This study showed that a comprehensive blood conservation program during adult on-pump cardiac surgery was effective in reducing the transfusion of RBC without adversely affecting outcomes. 49 An additional key component of PBM is optimizing the patient's own blood reserves before surgery. This approach was assessed in a retrospective Canadian cohort study, including 532 patients referred to an outpatient blood conservation clinic before cardiac surgery.…”

Section: Updates On Transfusion Studies In Cardiac Surgerymentioning

confidence: 99%

Coagulation and Transfusion Updates From 2021

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Patel

Henderson

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…This program was associated with reduced perioperative red blood cell (RBC) transfusion rates and decreased risks of mortality and complications. 7 It revealed that CPB process plays a key role in the blood management of cardiac surgery, and perfusionists' transfusion concept may have a positive impact on the whole perioperative transfusion practice.…”

Section: Introductionmentioning

confidence: 99%

“…Our previous study highlighted the significance of a comprehensive blood conservation program, which included a restrictive transfusion strategy, ultrafiltration, cell salvage, residual pump blood ultrafiltration, and a modified minimal extracorporeal circulation (MECC) system. This program was associated with reduced perioperative red blood cell (RBC) transfusion rates and decreased risks of mortality and complications 7 . It revealed that CPB process plays a key role in the blood management of cardiac surgery, and perfusionists' transfusion concept may have a positive impact on the whole perioperative transfusion practice.…”

Section: Introductionmentioning

confidence: 99%

A transfusion risk stratification score to facilitate quality management in cardiopulmonary bypass

et al. 2023

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BackgroundOur previous showed that a blood management program in the cardiopulmonary bypass (CPB) department, reduced red blood cell (RBC) transfusion and complications, but assessing transfusion practice solely based on transfusion rates was insufficient. This study aimed to design a risk stratification score to predict perioperative RBC transfusion to guide targeted measures for on‐pump cardiac surgery patients.Study Design and MethodsWe analyzed data from 42,435 adult cardiac patients. Eight predictors were entered into the final model including age, sex, anemia, New York Heart Association classification, body surface area, cardiac surgery history, emergency surgery, and surgery type. We then simplified the score to an integer‐based system. The area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow goodness‐of‐fit test, and a calibration curve were used for its performance test. The score was compared to existing scores.ResultsThe final score included eight predictors. The AUC for the model was 0.77 (95% CI, 0.76–0.77) and 0.77 (95% CI, 0.76–0.78) in the training and test set, respectively. The calibration curves showed a good fit. The risk score was finally grouped into low‐risk (score of 0–13 points), medium‐risk (14–19 points), and high‐risk (more than 19 points). The score had better predictive power compared to the other two existing risk scores.DiscussionWe developed an effective risk stratification score with eight variables to predict perioperative RBC transfusion for on‐pump cardiac surgery. It assists perfusionists in proactively preparing blood conservation measures for high‐risk patients before surgery.

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Quality Management of a Comprehensive Blood Conservation Program During Cardiopulmonary Bypass

Cited by 10 publications

References 19 publications

Dose-dependent influence of red blood cell transfusion volume on adverse outcomes in cardiac surgery

Dose-dependent influence of red blood cell transfusion volume on adverse outcomes in cardiac surgery

Coagulation and Transfusion Updates From 2021

A transfusion risk stratification score to facilitate quality management in cardiopulmonary bypass

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