Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines

Stover, E P; Siegel, Lawrence C.; Parks, RW; Levin, Jack; Body, Simon C.; Spiess, Bruce D.; D’Ambra, Michael N.; Maddi, Rosemarie

doi:10.1097/00000542-199409001-01224

Cited by 39 publications

(48 citation statements)

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“…Despite different national consensus guidelines, several American and European multicenter studies demonstrated a substantial variability in perioperative transfusion practice. [4][5][6][7][8] Even in a selected patient population at low risk for transfusion therapy, the percentage of patients transfused and the median number of units transfused per patient varied considerably between institutions. 6 The SANGUIS study evaluated blood product use in 43 teaching hospitals from ten European countries, and found that transfusion rates depend more on physicians than on type of procedure, patient population or hospital.…”

Section: Résultatsmentioning

confidence: 99%

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

et al. 2001

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Section: Résultatsmentioning

confidence: 99%

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

et al. 2001

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“…18 Rejection of the hypothesis that the theoretical area under the curve is 50% provides evidence that RCV has the ability to distinguish between the two groups. 1 8 Nevertheless, transfusion practice is institution dependent 19,20 and, therefore, the figure of 2070 ml may not be a valid cutpoint for red cell volume in all cardiac surgery centres. Thus each institution should determine, in the light of their transfusion practice, the cutpoint under which allogeneic transfusion becomes more likely in ABD patients.…”

Section: Discussionmentioning

confidence: 99%

Transfusions in patients undergoing cardiac surgery with autologous blood

Hardy

Harel

Bélisle

2000

Can J Anesth/J Can Anesth

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705CAN J ANESTH 2000 / 47: 7 / pp [705][706][707][708][709][710][711] Purpose: Determinants of allogeneic blood use in cardiac surgery include preoperative factors such as female sex, age, body weight, hematocrit and red cell volume. We verified if these variables also predicted the need for allogeneic transfusions when autologous blood is predonated.Methods: Demographic and intraoperative variables, hemoglobin concentrations and transfusion requirements in patients undergoing cardiopulmonary bypass with autologous blood predonation were reviewed. Multivariate logistic regression and RECPAM tree-growing analyses were applied to identify the preoperative predictors of allogeneic transfusion in these patients.Results: Data from 230 patients included in our autologous blood program between 1995 and 1998 were analysed. Patients undergoing complex/reoperative surgical procedures and patients over age 64yr with a low red cell volume (<2070ml) undergoing simple procedures were more likely to require allogeneic red cells. Younger patients with a low red cell volume undergoing simple procedures carried an intermediate risk. Allogeneic transfusion was avoided in 95% of patients undergoing simple procedures when red cell volume $ 2070ml.Conclusions: In our institution, complex/reoperative surgery, low red cell volume and increased age are the main factors associated with the need for allogeneic red cell transfusion despite autologous blood predonation. Knowledge of the factors that limit the effectiveness of predonation with respect to allogeneic blood exposure should help clinicians decide which cardiac surgical patients should be included in autologous blood programs.Objectif : Parmi les déterminants de l'utilisation de sang allogénique en cardiochirurgie, on retrouve des facteurs préopératoires comme le sexe féminin, l'âge, la masse corporelle, l'hématocrite et le volume globulaire. Nous avons voulu vérifier si ces variables prédisaient aussi le besoin de transfusions allogéniques dans les cas d'un don autologue préopératoire. Méthode : Les variables démographiques et peropératoires, les concentrations d'hémoglobine et les conditions de transfusion ont été révisées chez des patients qui subissent une circulation extracorporelle avec du sang autologue prélevé avant l'opération. Des analyses de régression logistique multifactorielle et de partition et amalgamation récursive ont été appliquées pour identifier les facteurs prédictifs préopératoires de transfusion allogénique chez ces patients. Résultats : Des données sur 230 patients admis dans notre programme de sang autologue entre 1995 et 1998 ont été analysées. Les patients qui subissent une intervention chirurgicale complexe ou une réopération et ceux qui ont plus de 64 ans, présentent un faible volume globulaire, <2070 ml), et subissent une intervention simple ont davantage besoin de globules rouges allogéniques. Les jeunes patients qui présentent un faible volume globulaire et subissent une opération simple sont moyennement à risque. La transfusion allogénique a été ...

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“…With the advent of blood-sparing procedures the need for blood transfusions has been reduced; however, cardiac surgery still consumes a large proportion of all red blood cell (RBC) transfusions, estimated to be approximately 20% of the total blood supply [2]. The transfusion rate for CABG varies greatly between hospitals, with a mean number of transfused units ranging from 0.4 to 6.3 units patient -1 [3,4].…”

Section: Introductionmentioning

confidence: 99%

Allogeneic leukocytes in cardiac surgery: Good or bad?

Bilgin¹,

Brand²

2011

Turk J Hematol

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Worldwide, cardiac surgery is a common procedure requiring a large quantity of allogeneic blood products, which are associated with postoperative complications. Leukocytes present in blood products may play a role in these complications, which are referred to as transfusion-related immunomodulation (TRIM). Several randomized controlled trials (RCTs) in different settings investigated the effects of allogeneic leukocytes in red blood cells (RBCs). Cardiac surgery studies reported a reduction in postoperative infections and mortality in patients that received leukocyte-reduced RBCs compared with leukocyte-containing RBCs; this was mainly due to more deaths due to infections and multiple organ dysfunction syndrome (MODS) in the group that received leukocyte-containing RBCs. Patients with postoperative complications had higher concentrations of inflammatory mediators. These findings suggest that leukocytecontaining transfusion during cardiac surgery induces a second insult to the systemic inflammatory response. In the present review we discuss the possible role of blood transfusions in cardiac surgery. Especially, we focus on the possible role of allogeneic leukocytes associated with postoperative complications after cardiac surgery. (Turk J Hematol 2011; 28: 160-9) Key words: Blood transfusions, transfusion-related immunomodulation, leukodepletion, infections, mortality, cardiac surgery (Turk J Hematol 2011; 28: 160-9) Anahtar kelimeler: Kan transfüzyonları, transfüzyon ile ilişkili immünomodülasyon, lökodeplesyon, enfeksiyonlar, mortalite, kardiyak cerrahisi

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Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines

Cited by 39 publications

References 0 publications

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

Transfusions in patients undergoing cardiac surgery with autologous blood

Allogeneic leukocytes in cardiac surgery: Good or bad?

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