Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

Abstract

Objective: To review current literature evidence on outcomes of cardiac surgery in Jehovah’s Witness patients. Methods: A comprehensive electronic literature search was done from 2010 to 20th August 2020 identifying articles that discussed optimisation/outcomes of cardiac surgery in Jehovah’s Witness either as a solo cohort or as comparative to non-Jehovah’s Witnesses. No limit was placed on place of publication and the evidence has been summarised in a narrative manner within the manuscript. Results: The outcomes of cardiac surgery in Jehovah’s Witness patients has been described, and also compared, to non-Witness patients within a number of case reports, case series and comparative cohort studies. Many of these studies note no significant differences between outcomes of the two groups for a number of variables, including mortality. Pre-, intra and post-operative optimisation of the patients by a multidisciplinary team is important to achieve good outcomes. Conclusion: The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.

Perioperative management of patients declining transfusions of blood components—National survey of anaesthesiologists, abdominal surgeons and obstetricians in Denmark

“…Only two departments had local guidelines addressing clinical interventions for patients declining transfusion of blood components. This is in contrast with current knowledge that successful multidisciplinary planning and blood management reduces transfusion of blood components as well as blood loss 2,4,11,12,23,29 . Minimising blood loss perioperatively reduces risk of adverse events 1–4,10,30 …”

“…6,13,15,28 components as well as blood loss. 2,4,11,12,23,29 Minimising blood loss perioperatively reduces risk of adverse events. [1][2][3][4]10,30 Lack of local guidelines inherently force physicians to make more individual decisions.…”

“…Local guidelinesThirty-five (37%, 95% CI[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] respondents reported having a local guideline for managing patients declining transfusion of blood components at their department or hospital. Eleven of the 35 respondents attached local guidelines.…”

“…Seven of 96 (7%, 95% CI 3-15) respondents reported limiting blood sampling (small vials) before surgery. Twenty-seven consultants (28%, 95% CI 20-38) reported screening for coagulopathy.T A B L E 1 INR (27%, 95% CI 19-37) and platelet count (26%, 95% CI[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] …”

Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond

“…In the case law of Re C (adult: refusal of medical treatment) [1994] 1 All ER 819 (QBD) [10], it can be concluded that a clinician is to respect patient decision, even if the patient’s decision goes against the patient’s best interests in the eyes of the clinician as long as the patient is deemed to have capacity [10,11]. In cases of emergencies, where it is difficult to gain consent or unlikely for patient to have capacity, many patients who stand against use of transfusions during treatment keep an advanced directive card, which identifies their preference regarding blood transfusions, including whether they refuse all types of blood transfusion or certain components only [12].…”