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Heymann, Christian von; Sander, Michael; Foer, Achim; Heinemann, Anja; Spiess, Bruce D.; Braun, J.; Kramer, Michael D.; Grosse, Joachim; Dohmen, Pascal M.; Dushe, Simon; Halle, Jürgen; Konertz, Wolfgang; Wernecke, Klaus‐Dieter; Spies, Claudia

doi:10.1186/cc4891

Cited by 49 publications

(10 citation statements)

References 26 publications

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“…In a small randomized trial of 54 coronary artery bypass grafting patients, in which individuals received transfusions to maintain a hematocrit above 25% vs 20%, no differences in clinical outcomes nor oxygen delivery were found [19]. In another study of 428 coronary artery bypass graft patients randomized to transfusion for goal hemoglobin exceeding 8 g/dL vs exceeding 9 g/dL, clinical outcomes and mortality did not differ between the groups [8].…”

Section: Commentmentioning

confidence: 99%

Intraoperative Hemoglobin Levels and Transfusion Independently Predict Stroke After Cardiac Operations

Bahrainwala

Grega

Hogue

et al. 2011

The Annals of Thoracic Surgery

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Background Anemia has been associated with adverse cerebrovascular outcomes, particularly after cardiac operations. This study was conducted to determine if hemoglobin levels during and after cardiopulmonary bypass (CPB) predict postoperative stroke in cardiac surgical patients, independent of transfusion requirements. Methods Individuals who had sustained a clinical postoperative stroke (cases) were matched 1:2 with controls by age, sex, surgical procedure, and year of operation. In 617 patients, conditional logistic regression was performed to analyze associations between hemoglobin levels before and after CPB, and stroke. Results After adjustment for potentially confounding vascular risk factors, lower hemoglobin after CPB was associated with a higher risk of stroke, even after adjustment for the amount of packed red blood cells transfused (adjusted odds ratio, 1.28; 95% confidence interval, 1.00 to 1.64, per point of lower hemoglobin level; adjusted odds ratio for stroke per higher quartile of packed red blood cells transfused in this model, 1.37; 95% confidence interval, 1.02 to 1.83). Similar associations were not found for hemoglobin concentrations preoperatively nor change in hemoglobin from before to after CPB. A post-CPB hemoglobin level below the median was associated with 37% increased odds of a postoperative stroke occurring (p = 0.02). Conclusions Lower postoperative hemoglobin levels and higher intraoperative transfusion requirements are each independently associated with a higher risk of stroke. Reduced cerebral oxygen delivery due to anemia may contribute to cerebral injury after coronary artery bypass grafting.

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Section: Commentmentioning

confidence: 99%

Intraoperative Hemoglobin Levels and Transfusion Independently Predict Stroke After Cardiac Operations

Bahrainwala

Grega

Hogue

et al. 2011

The Annals of Thoracic Surgery

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“…Despite its theoretical benefits in reducing RBC transfusions, single center reports and meta-analyses have demonstrated mixed results regarding the effectiveness of ANH to reduce RBC transfusions. 5 6–9,10–12 . In its most recent blood management guidelines, the Society of Thoracic Surgeons and Society of Cardiovascular Anesthesiologists endorse ANH as a potential mechanism for blood conservation, but acknowledged the disparate data supporting its practice.…”

Section: Introductionmentioning

confidence: 99%

Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery

Goldberg

Paugh

Dickinson³

et al. 2015

The Annals of Thoracic Surgery

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Background Perioperative red blood cell transfusions (RBC) are associated with increased morbidity and mortality after cardiac surgery. Acute normovolemic hemodilution (ANH) is recommended to reduce perioperative transfusions; however, supporting data are limited and conflicting. We describe the relationship between ANH and RBC transfusions after cardiac surgery using a multi-center registry. Methods We analyzed 13,534 patients undergoing cardiac surgery between 2010 and 2014 at any of the 26 hospitals participating in a prospective cardiovascular perfusion database. The volume of ANH (no ANH, <400mL, 400–799mL, ≥800mL) was recorded and linked to each center’s surgical data. We report adjusted relative risks reflecting the association between the use and amount of ANH and the risk of perioperative RBC transfusion. Results were adjusted for preoperative risk factors, procedure, BSA, preoperative HCT, and center. Results ANH was used in 17% of the patients. ANH was associated with a reduction in RBC transfusions (RRadj 0.74, p <0.001). Patients having ≥800mL of ANH had the most profound reduction in RBC transfusions (RRadj 0.57, p<0.001). Platelet and plasma transfusions were also significantly lower with ANH. The ANH population had superior postoperative morbidity and mortality compared to the no ANH population. Conclusions There is a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH. Our findings suggest the volume of ANH, rather than just its use, may be an important feature of a center’s blood conservation strategy.

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“…• Regulación de la FiO 2 entregada a través de la membrana de oxigenación por el mezclador de gases, para optimizar la presión parcial de oxígeno arterial (PaO 2 ). De este modo, la estrategia GDP podría permitir el manejo del paciente con mayor tolerancia a un nadir más bajo de los niveles de Hb, garantizando en todo momento una adecuado DO 2 i por medio del aumento de gasto de bomba 303 y reduciendo el uso de productos hemoderivados 304 . 98.…”

Section: Revisiónunclassified

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

et al. 2020

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The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

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Untitled

Cited by 49 publications

References 26 publications

Intraoperative Hemoglobin Levels and Transfusion Independently Predict Stroke After Cardiac Operations

Intraoperative Hemoglobin Levels and Transfusion Independently Predict Stroke After Cardiac Operations

Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

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