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Use of Intraoperative Hemostatic Checklists for Blood Management in Patients Undergoing Cardiac Surgery: A Scoping
Biobelemoye Irabor1, Asha Kothari2, Jonathan Hong3
1Cumming School of Medicine, University of Calgary, Calgary, Canada.
Insights
Intraoperative hemostatic checklists significantly reduce surgical re-exploration and blood product use in cardiac surgery patients. Further large studies are needed to confirm these benefits for routine clinical practice.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Intraoperative hemostatic checklists show potential to improve outcomes in cardiac surgery.
- Evidence is reviewed on their impact on bleeding and blood product transfusion.
Purpose of the Study:
- To review the current evidence on the effectiveness of intraoperative hemostatic checklists in cardiac surgery.
- To assess the impact of these checklists on surgical bleeding and perioperative blood product transfusion.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched Scopus, MEDLINE, EMBASE, Cochrane Library for relevant studies.
- Included randomized controlled and observational studies of adult cardiac surgery patients using hemostatic checklists.
Main Results:
- Four studies with 19,946 patients were included.
- Significant reduction in bleeding re-exploration rates observed.
- Reduced blood product transfusion, lower cost per patient, and shorter ICU stay noted in some studies.
Conclusions:
- Intraoperative hemostatic checklists may decrease surgical re-exploration and optimize blood product use post-cardiac surgery.
- Large multicenter trials are recommended to support widespread clinical adoption.
Background:
Using intraoperative hemostatic checklists may improve rates of surgical re-exploration and utilization of allogenic blood products in patients undergoing cardiac surgery. In this review, the authors explore the current evidence describing the impact of using intraoperative hemostatic checklists on reducing rates of surgical bleeding and perioperative blood product transfusion in this group of patients.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic information was obtained via sources that included Scopus, MEDLINE, EMBASE, and the Cochrane Library. Specifically, randomized controlled and observational studies reporting on hemostatic checklists in cardiac surgery were assessed for the following inclusion criteria: adult patients undergoing cardiac surgery, use of an intraoperative hemostatic checklist, a comparative study design, and full text available in the English language. All conference abstracts, editorials, and other reviews were excluded.
Results:
A total of 3,022 articles were retrieved. Four articles, with 19,946 patients, were ultimately included in this review. These studies showed a significant reduction in bleeding re-exploration rates after implementing an intraoperative hemostatic checklist. In addition, three studies showed lower cost per patient, less blood product transfusion, and reduced intensive care unit stay after using checklists.
Conclusions:
These findings suggest that using intraoperative hemostatic checklists may reduce surgical re-exploration rates and improve blood product utilization after cardiac surgery. Large multicenter studies are needed to endorse the utilization of these checklists in routine clinical practice.
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