Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery

Virmani, Sanjula; Tempe, Deepak K; Pandey, Bhuvan C; Cheema, Amandeep S; Datt, Vishnu; Garg, Mukesh; Banerjee, Amit; Wadhera, Ashoo

doi:10.4103/0971-9784.58832

Cited by 22 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these 1,229 were excluded from further assessment at title and abstract screening, and 36 studies underwent full-text screening (Fig. Twelve studies did not report on our outcomes of interest (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Excluded Studies.…”

Section: Characteristics Of Included and Excluded Studiesmentioning

confidence: 99%

Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery

Curley

Shehata

Mazer

et al. 2014

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Characteristics Of Included and Excluded Studiesmentioning

confidence: 99%

Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery

Curley

Shehata

Mazer

et al. 2014

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The harvested blood, which has a greater red cell mass than the blood lost intra-operatively, is reinfused as needed during the procedure, with all removed blood returned at the completion of the operation. Several studies have evaluated the ability of ANH to reduce the need for perioperative allogenic transfusions, with mixed results, depending on the circumstances [5,10–12]. ANH has been particularly promising in patients undergoing major hepatic surgery, as well as other procedures with moderate-to-high blood loss (i.e., at least 1000 mL) [13,14].…”

Section: Introductionmentioning

confidence: 99%

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

Tanner

Filippova

Gardner

et al. 2018

Gynecologic Oncology

View full text Add to dashboard Cite

Objectives: Our objective was to determine the safety and efficacy of acute normovolemic hemodilution (ANH) to reduce the requirement for allogenic red blood cell (RBC) transfusions in patients undergoing primary cytoreduction for advanced ovarian cancer. Methods: Patients undergoing primary cytoreduction for advanced ovarian cancer were enrolled in a prospective trial assessing ANH at time of surgery. Intraoperative blood withdrawal was performed to a target hemoglobin of 8.0 g/dL. A standardized transfusion protocol first using autologous then allogenic blood was applied intraoperatively and throughout hospitalization according to institutional guidelines. The primary endpoint was to determine the overall rate of allogenic RBC transfusions in the intra- and postoperative periods. A predetermined allogenic RBC transfusion rate <35% was deemed a meaningful reduction from a 50% transfusion rate in historical controls. Results: Forty-one patients consented to participate. Median blood withdrawn during ANH was 1650 mL (range, 700–3000). Cytoreductive outcomes were as follows: 0 mm, 30 (73%); 1–10 mm, 8 (20%); and >10 mm, 3 (7%) residual disease. Estimated blood loss was 1000 mL (range, 150–2700). Fourteen patients (34%) received allogenic RBC transfusions intra- or postoperatively, meeting the primary endpoint. No patients were transfused outside protocol guidelines. The rate of ≥ grade 3 complications (20%) and anastomotic leaks (7%) were similar to historical controls and met predefined safety thresholds. Conclusions: For patients with advanced ovarian cancer undergoing primary cytoreductive surgery, ANH appears to reduce allogenic RBC transfusion rates versus historical controls without increasing perioperative complications. Further evaluation of the technique is warranted.

show abstract

“…However, the utility of mild volume ANH in reducing allogeneic blood transfusions in cardiac surgery is still controversial. Several studies have proved that mild volume ANH was not effective in reducing the number of allogeneic erythrocytes units [ 8 , 23 ], but others have proven otherwise [ 6 ]. Our results support the positive finding that mild volume ANH could reduce intraoperative blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study

et al. 2017

View full text Add to dashboard Cite

BackgroundPerioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al., Lancet 387:1905, 2016; Ferraris et al., Ann Thorac Surg 91:944–82, 2011). Acute normovolemic hemodilution (ANH) is recommended as a potential strategy during cardiac surgery, but the blood conservation effect and the degree of ANH was still controversial. There is also an increasing concern about the improved outcomes associated with ANH. Therefore, a better understanding of the effect of mild volume ANH during cardiac surgery is urgently needed.MethodsThis retrospective study included 2058 patients who underwent cardiac surgery between 2010 and 2015. The study population was split into two groups (with and without mild volume ANH). Propensity score adjustment analysis was applied. We reported the association between the use of mild volume ANH and perioperative outcomes.ResultsA total of 1289 patients were identified. ANH was performed in 358 patients, and the remaining 931 patients did not receive any ANH. Five hundred of the total patients (38.8%) received perioperative RBC transfusions, 10% (129/1289) of patients received platelet, and 56.4% (727/1289) of patients received fresh frozen plasma transfusions. Mild volume ANH administration was significantly associated with decreased intraoperative RBC transfuse rate (8.5% vs. 14.4%; p = 0.013), number of RBC units (p = 0.019), and decreased postoperative pulmonary infection (6.8 vs. 11.3%; p = 0.036) during cardiac surgery. However, there was no significant difference regarding intraoperative fresh frozen plasma (FFP) and platelet concentrate transfusions, as well as postoperative and total perioperative allogeneic transfusions. Furthermore, there was no significant difference regarding postoperative outcomes including mortality, prolonged wound healing, stroke, atrial fibrillation, reoperation for postoperative bleeding and acute kidney injury. There was also no difference in postoperative ventilation time, length of ICU and hospital stay.ConclusionBased on the 5-year experience of mild volume ANH in cardiac surgeries with CPB in our large retrospective cohort, mild volume ANH was associated with decreased intraoperative RBC transfusion and postoperative pulmonary infection in Chinese patients undergoing cardiac surgery. However, there was no significant difference regarding postoperative and total perioperative allogeneic transfusions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0305-7) contains supplementary material, which is available to authorized users.

show abstract

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery

Cited by 22 publications

References 21 publications

Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery

Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study

Contact Info

Product

Resources

About