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The safety and efficacy of "bloodless" cardiac surgery
Aryeh Shander1, David Moskowitz, Tanuja S Rijhwani
1Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07361, USA. aryeh.shander@ehmc.com
Insights
Nearly 20% of cardiac surgeries involve blood transfusions. Implementing blood conservation techniques could reduce these transfusions by 75%, preserving vital blood resources and lowering costs.
Area of Science:
- Cardiology
- Transfusion Medicine
- Surgical Oncology
Background:
- Approximately 20% of all blood transfusions in the U.S. are linked to cardiac surgery.
- Despite available blood conservation methods, significant transfusion rates persist in these procedures.
- Physician and institutional practices, rather than patient factors, often drive transfusion decisions.
Purpose of the Study:
- To highlight the high rates of blood transfusion in cardiac surgery.
- To emphasize the potential of blood conservation techniques to reduce transfusion needs.
- To advocate for a reevaluation of allogeneic transfusion practices in cardiac surgery.
Main Methods:
- Review of current blood conservation techniques applicable to cardiac surgery.
- Analysis of factors contributing to high transfusion rates.
- Evaluation of the potential impact of implementing conservation strategies.
Main Results:
- Blood conservation strategies, when applied individually or in combination, can potentially decrease unnecessary transfusions by an estimated 75%.
- High transfusion rates in cardiac surgery are influenced by practice patterns, not solely by patient condition or blood loss.
- Significant variations in transfusion rates exist among different medical centers.
Conclusions:
- Revisiting allogeneic transfusion practices in cardiac surgery is crucial.
- Widespread adoption of blood conservation techniques can significantly reduce transfusion requirements.
- Implementing these strategies can conserve blood supplies and mitigate transfusion-related costs and complications.
Abstract:
Nearly 20% of blood transfusions in the United States are associated with cardiac surgery. Despite the many blood conservation techniques that are available, safe, and efficacious for patients undergoing cardiac surgery, many of these operations continue to be associated with significant amounts of blood transfusion. Although surgical bleeding after cardiopulmonary bypass is a common problem as reflected by the substantial use of blood products, it is the individual physician and institutional behavior that have been identified as reasons for transfusion and not necessarily patient comorbidity or blood loss. Transfusion rates in cardiac surgery remain high despite major advances in perioperative blood conservation, with large variations among individual centers. The adoption of available blood conservation techniques, either alone or in combination in patients undergoing cardiac surgery, could result in an estimated 75% reduction of unnecessary transfusions. The success of previously reported blood conservations programs in cardiac surgery should call for a reevaluation of allogeneic transfusion practices in patients undergoing cardiac surgery. By applying the numerous reported blood conservation strategies for the management of patients presenting for cardiac surgery, we can preserve our dwindling blood resources and help alleviate some of the direct costs of blood as well as the indirect costs of treating noninfectious and infectious complications of transfusion.
