Determinants of Blood Utilization during Myocardial Revascularization

Cosgrove, Delos M.; Loop, Floyd D.; Lytle, Bruce W.; Gill, Carl C.; Golding, Leonard R.; Taylor, Paul C.; Forsythe, Sarah B.

doi:10.1016/s0003-4975(10)60073-2

Cited by 196 publications

(87 citation statements)

References 14 publications

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“…This is consistent with several previous studies in which demographic details, comorbidities, conventional pre‐operative laboratory test results31, 32, 33, 34, 35, and procedural characteristics31, 35 contributed to prediction of RBC transfusion. The baseline‐only model confirmed that exposure to anti‐platelet drugs before cardiac surgery is also a strong predictor of post‐operative bleeding 17, 20.…”

Section: Discussionsupporting

confidence: 92%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Section: Discussionsupporting

confidence: 92%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…The use of blood conservation during cardiac surgery has been used with great success at the Cleveland Clinic [1]. There, patients did not receive packed red cells until the hematocrit fell below 22%.…”

Section: Discussionmentioning

confidence: 99%

“…The indications and limitations for the perioperative administration of blood components in surgical patients are now better defined [14][15][16]. The use of fewer red cell transfusions in cardiac surgery is supported by the lack of morbidity in postoperative patients who tolerate hematocrits of 25 to 30% [1,17,18]. There is considerable experience with Jehovah's witnesses who receive no blood during cardiac surgery and tolerate hemoglobin levels as low as 50 gm/L without suffering increased morbidity [19].…”

Section: Discussionmentioning

confidence: 99%

“…1991; 11 (2): [213][214][215][216][217] Modern transfusion practice in cardiac surgery is directed toward keeping the number of administered blood bank products to a minimum. In some hospitals, over 90% of patients undergoing coronary artery bypass grafting (CABG) do not receive any blood products as part of a comprehensive blood conservation program [1]. We recently reevaluated our use of blood products and embarked on a program to reduce the amount of patient exposure to infectious agents such as HIV-1 and hepatitis viruses.…”

Section: Accepted For Publication 30 May 1990mentioning

confidence: 99%

See 1 more Smart Citation

Limiting the Usage of Blood Products in Cardiovascular Surgery

1991

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We studied the effect of the initiation of a five part program of blood component conservation on blood product utilization in patients undergoing major cardiovascular surgery. We encouraged physicians and nurses to adhere to a set of guidelines that would limit the exposure of these patients to complications associated with blood product administration. Through this effort the amounts of packed red cells, fresh frozen plasma, platelets, and cryoprecipitate used were markedly reduced. After the start of the conservation program, overall blood product usage was reduced 29% despite a 46% increase in the surgical caseload, and there was a 53% decrease in the amount of donor exposure (units of individual blood products administered) per patient. Surgery. 1991; 11(2): 213-217 Modern transfusion practice in cardiac surgery is directed toward keeping the number of administered blood bank products to a minimum. In some hospitals, over 90% of patients undergoing coronary artery bypass grafting (CABG) do not receive any blood products as part of a comprehensive blood conservation program [1]. We recently reevaluated our use of blood products and embarked on a program to reduce the amount of patient exposure to infectious agents such as HIV-1 and hepatitis viruses. This effort was based on the following maneuvers whenever possible: removal of 450 to 900 ml of the patient's blood prior to cardiopulmonary bypass with reinfusion after reversal of heparinization; reinfusion of all possible blood from the oxygenator at the conclusion of bypass; withholding the prophylactic administration of fresh frozen plasma (FFP), platelets, and cryoprecipitate until laboratory tests indicated specific coagulation deficits; acceptance of postoperative normovolemic anemia (hematocrit, 25-30%); and reinfusion of postoperative mediastinal drainage. We report here the results of a concerted effort in the operating room and ICU to use less blood products in patients undergoing a variety of cardiac surgical operations. PE Horowitz, CM Lorenzen, RD Rhydderch, Limiting the Usage of Blood Products in Cardiovascular MethodsWe studied the blood product utilization of all patients at our hospital who were undergoing CABG, single valve replacement or repair, multiple valve operations, reoperations for valve repair or replacement, closure of atrial septal defect in patients above and below 16 years of age, and ventriculoseptal defect closure. All patients undergoing these operations from February 1 to August 31, 1988, were placed in the control group (Group I). A second group of patients operated on from May 1 to October 31, 1989 (Group II), was studied after the introduction of a new set of procedures and guidelines governing blood product administration. Limiting The Usage of Blood Products in Cardiovascular SurgeryAnnals of Saudi Medicine, Vol 11 No. 2; 1991 The following conservation techniques were utilized whenever possible for the patients in Group II: 1. Withdrawal of 450 to 900 ml of the patient's blood from the sideport of an 8.5 F percut...

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“…7 In the absence of predonation, determinants of allogeneic blood use during myocardial revascularization have been identified to include preoperative factors such as female sex, age, body weight, preoperative hematocrit and red blood cell volume. [8][9][10][11][12][13] Given the potential risks of conducting ABD in patients about to undergo cardiac surgery, we thought it would be important to verify if these or other preoperative determinants of allogeneic blood use applied to our ABD patient population. We postulate that identification of factors determining the need for allogeneic blood despite ABD may help clinicians decide which patients are most likely to benefit (with respect to allogeneic blood exposure) from this blood sparing strategy.…”

Section: Occasional Reviewmentioning

confidence: 99%

Transfusions in patients undergoing cardiac surgery with autologous blood

Hardy

Harel

Bélisle

2000

Can J Anesth/J Can Anesth

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705CAN J ANESTH 2000 / 47: 7 / pp [705][706][707][708][709][710][711] Purpose: Determinants of allogeneic blood use in cardiac surgery include preoperative factors such as female sex, age, body weight, hematocrit and red cell volume. We verified if these variables also predicted the need for allogeneic transfusions when autologous blood is predonated.Methods: Demographic and intraoperative variables, hemoglobin concentrations and transfusion requirements in patients undergoing cardiopulmonary bypass with autologous blood predonation were reviewed. Multivariate logistic regression and RECPAM tree-growing analyses were applied to identify the preoperative predictors of allogeneic transfusion in these patients.Results: Data from 230 patients included in our autologous blood program between 1995 and 1998 were analysed. Patients undergoing complex/reoperative surgical procedures and patients over age 64yr with a low red cell volume (<2070ml) undergoing simple procedures were more likely to require allogeneic red cells. Younger patients with a low red cell volume undergoing simple procedures carried an intermediate risk. Allogeneic transfusion was avoided in 95% of patients undergoing simple procedures when red cell volume $ 2070ml.Conclusions: In our institution, complex/reoperative surgery, low red cell volume and increased age are the main factors associated with the need for allogeneic red cell transfusion despite autologous blood predonation. Knowledge of the factors that limit the effectiveness of predonation with respect to allogeneic blood exposure should help clinicians decide which cardiac surgical patients should be included in autologous blood programs.Objectif : Parmi les déterminants de l'utilisation de sang allogénique en cardiochirurgie, on retrouve des facteurs préopératoires comme le sexe féminin, l'âge, la masse corporelle, l'hématocrite et le volume globulaire. Nous avons voulu vérifier si ces variables prédisaient aussi le besoin de transfusions allogéniques dans les cas d'un don autologue préopératoire. Méthode : Les variables démographiques et peropératoires, les concentrations d'hémoglobine et les conditions de transfusion ont été révisées chez des patients qui subissent une circulation extracorporelle avec du sang autologue prélevé avant l'opération. Des analyses de régression logistique multifactorielle et de partition et amalgamation récursive ont été appliquées pour identifier les facteurs prédictifs préopératoires de transfusion allogénique chez ces patients. Résultats : Des données sur 230 patients admis dans notre programme de sang autologue entre 1995 et 1998 ont été analysées. Les patients qui subissent une intervention chirurgicale complexe ou une réopération et ceux qui ont plus de 64 ans, présentent un faible volume globulaire, <2070 ml), et subissent une intervention simple ont davantage besoin de globules rouges allogéniques. Les jeunes patients qui présentent un faible volume globulaire et subissent une opération simple sont moyennement à risque. La transfusion allogénique a été ...

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Determinants of Blood Utilization during Myocardial Revascularization

Cited by 196 publications

References 14 publications

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Limiting the Usage of Blood Products in Cardiovascular Surgery

Transfusions in patients undergoing cardiac surgery with autologous blood

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