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Blood use in cardiac surgery and the limitations of hemodilution
1Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Blood transfusion practices in cardiac surgery have evolved significantly due to hemodilution research. This review details blood conservation methods, physiological effects, and future trends in transfusion therapy.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Physiology
Background:
- Cardiac surgery practices have seen major shifts in blood product utilization over 30 years.
- Understanding hemodilution has been central to these changes in transfusion protocols.
Purpose of the Study:
- To review the evolution of blood transfusion in cardiac surgery.
- To examine blood conservation strategies and the physiological impact of hemodilution.
Main Methods:
- Review of blood conservation techniques: preoperative, intraoperative, and postoperative.
- Analysis of physiological effects and limitations of hemodilution in adult and pediatric patients.
- Examination of current trends in blood component therapy and blood substitutes.
Main Results:
- Significant advancements in blood conservation methods have reduced transfusion needs.
- Hemodilution presents specific physiological effects and limitations in various patient populations.
- Blood component therapy and emerging blood substitutes are reshaping transfusion strategies.
Conclusions:
- Cardiac surgery transfusion practices have been revolutionized by hemodilution insights.
- Comprehensive blood conservation strategies are crucial for optimizing patient outcomes.
- Future directions include advanced component therapy and innovative blood substitutes.
Abstract:
The use of blood and blood products in cardiac surgery has undergone marked changes over the past three decades. This revolution occurred primarily through the study and understanding of hemodilution. This review marks the changes in the practice of blood transfusion in cardiac surgery. We review the methods of blood conservation through preoperative screening and preparation, intraoperative drug therapy and modification of surgical techniques, and postoperative use of shed mediastinal blood. We also examine the physiologic effects and limitations of hemodilution in adult and pediatric cardiac surgery. Finally, we review the recent trends in the use of blood component therapy and the future of blood substitutes.