Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Patient Blood Management

Background:

• High-risk cardiac surgery with cardiopulmonary bypass (CPB) is associated with significant bleeding and need for allogeneic blood transfusions.
• Acute normovolemic hemodilution (ANH) is a blood conservation technique with potential to mitigate these risks.
• A standardized approach for ANH implementation and performance is needed.

Purpose of the Study:

• To develop a standardized approach for implementing and performing ANH.
• To reduce bleeding and allogeneic blood transfusion incidence in high-risk cardiac surgery patients undergoing CPB.

Main Methods:

• A 2-round modified RAND-Delphi consensus process involving physicians and a perfusionist.
• Integration of evidence review with a face-to-face multidisciplinary expert panel meeting.
• Repeated scoring using a 9-point Likert scale to determine consensus on ANH acceptability and contraindications.

Main Results:

• 18 key manuscripts were reviewed, and 39 statements regarding ANH contraindications and CPB patient variables were assessed.
• Consensus was reached on 22 statements after the second scoring round.
• Agreement was achieved on 6 specific conditions for ANH acceptability or non-acceptability.

Conclusions:

• Development of a standardized ANH approach for high-risk surgical bleeding and transfusion reduction is feasible.
• The expert panel's recommendations can guide the management and integration of ANH.
• ANH can be established as an evidence and consensus-based blood conservation modality.