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Non-pharmacological strategies for blood conservation in cardiac surgery
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada.
Insights
Non-pharmacological strategies for reducing blood transfusions in cardiac surgery vary in effectiveness. While some methods like preoperative autologous donation show promise, many require further study, with rational transfusion guidelines remaining key for blood conservation.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Cardiac surgery frequently involves coagulopathy, significant blood loss, and a high need for transfusions.
- Allogeneic blood transfusions pose risks to patients and strain blood supply resources.
- Reviewing non-pharmacological blood conservation strategies is crucial for patient safety and resource management.
Purpose of the Study:
- To review current non-pharmacological strategies for decreasing allogeneic blood use in cardiac surgical patients.
- To appraise the effectiveness and applicability of various blood conservation techniques.
Main Methods:
- Comprehensive literature search and review of studies on blood conservation strategies.
- Appraisal of meta-analyses and subsequent reports to evaluate evidence quality.
- Assessment of study limitations, including lack of transfusion guidelines and blinding.
Main Results:
- Preoperative autologous donation is effective but costly and limited to elective cases.
- Off-pump revascularization may reduce transfusion needs in select patients.
- Effectiveness of other methods like hemodilution and cell salvage is difficult to ascertain due to study limitations; biological glues and PEEP increases show no efficacy.
Conclusions:
- Many blood conservation modalities require further research for routine cardiac surgery application.
- The effectiveness and applicability of numerous strategies remain controversial.
- Judicious use of evidence-based transfusion guidelines is currently the most effective and cost-efficient blood conservation method.
Purpose:
Of all surgical specialties, cardiac operations are most often associated with coagulopathy, blood loss, and the need for transfusions. This not only represents a major burden on blood procurement and banking organizations at all levels, but also constitutes a risk for each patient receiving allogeneic blood products. This paper reviews current non-pharmacological strategies aimed at decreasing blood use in patients undergoing cardiac surgery.
Source:
The literature pertaining to each blood conservation strategy was searched, reviewed, and appraised. Meta- analyses were also consulted and their results complemented with subsequent reports when available.
Principal Findings:
Preoperative autologous donation programs are effective in decreasing allogeneic transfusions, but are costly and applicable to elective patients only. Off-pump revascularization strategies also appear to decrease transfusion requirements in suitable patients. The effectiveness of acute normovolemic hemodilution, retrograde autologous priming, small volume cardiopulmonary bypass circuits, platelet-rich plasmapheresis, alternative heparin strategies, and postoperative cell salvage are more difficult to appraise as a high proportion of available studies suffer from lack of transfusion guidelines or the absence of blinding. Biological glues, surgical adhesives, and postoperative increases in positive end-expiratory pressure (PEEP) have no demonstrated efficacy.
Conclusion:
The applicability or effectiveness of many of these modalities remains controversial and more studies are needed before they may be employed routinely in cardiac surgical patients. The judicious use of rational transfusion guidelines may still be the simplest and most cost-effective means of blood conservation today.