Patient blood management for patients undergoing cardiac surgery in Middle Eastern countries: Multicenter survey

The purpose of this survey was to delineate and compare patient blood management (PBM) approaches in cardiac surgery across nine Middle Eastern countries while identifying the main challenges against the implementation of the PBM program in cardiac surgery as reported by the surveyed centers.

An online survey was established to assess current PBM practices in surveyed countries, including risk factors for bleeding or transfusion, management of preoperative anemia in elective cases, and antifibrinolytic use.

This questionnaire was conducted among cardiac anesthesiologists in Middle Eastern countries in 2024.

Only doctors participated voluntarily in this survey.

No intervention.

We assessed the extent of adoption of PBM practices in surveyed countries for patients who underwent cardiac surgery with cardiopulmonary bypass.

Of 40 survey responses, 26 (60%) were eligible for analysis. Most respondents were cardiac anesthesiologists. Key risk factors of bleeding or transfusion identified by over 70% of respondents included redo cardiac surgery, preoperative anemia, recent clopidogrel use, thrombocytopenia <100 × 10⁹/L, and oral anticoagulants. More than half of the centers would correct preoperative anemia using iron. Tranexamic acid was universally used, though administration regimens varied. Autologous priming and normothermia were the most common bypass strategies that would be used by more than 50% of respondents. Viscoelastic testing was available in more than 70% of centers and used by more than half of respondents in case of clinical bleeding.

PBM practices in Middle Eastern cardiac centers are heterogeneous, reflecting inconsistent adoption of guidelines. Enhanced training, institutional support, and homogenized national protocols are needed to standardize PBM in the region.