Rationalizing blood transfusion in cardiac surgery: the impact of a red cell volume‐based guideline on blood usage and clinical outcome

Abstract

In elective cardiac surgery patients, considering haemoglobin concentration alone may overestimate the requirement for red cell transfusion. More research is required to determine the impact of restrictive transfusion policies on clinical outcome following cardiac surgery.

Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery

“…Seven studies were randomized trials of different transfusion thresholds (21,(37)(38)(39)(40)(41)(42). We included 21 full-text articles for review.…”

“…Seven studies were randomized trials of different transfusion thresholds (21,(37)(38)(39)(40)(41)(42). Of the seven included transfusion threshold trials, two studies enrolled patients undergoing elective myocardial revascularization only (37,39), four recruited patients who had myocardial revascularization and/or valve repair or replacement (21,(40)(41)(42), and one study was of vascular surgery patients (38). Table 1 describes the patient population, the trial interventions, and outcomes.…”

“…Ten trials used only ANH (43)(44)(45)(46)(47)(48)(49)(50)(51)(52), whereas four trials involved pediatric patients, two comparing different postoperative transfusion thresholds (53,54) and two using only ANH (55,56). Six studies excluded patients with significant comorbidities, including severe left ventricular dysfunction and renal dysfunction (21,(37)(38)(39)(40)42). Of the seven included transfusion threshold trials, two studies enrolled patients undergoing elective myocardial revascularization only (37,39), four recruited patients who had myocardial revascularization and/or valve repair or replacement (21,(40)(41)(42), and one study was of vascular surgery patients (38).…”

“…Four studies used intra-and postoperative thresholds (21,38,41,42), two studies used postoperative thresholds only (37,39), and one study used preoperative transfusion only (40). Four studies used intra-and postoperative thresholds (21,38,41,42), two studies used postoperative thresholds only (37,39), and one study used preoperative transfusion only (40).…”

“…The quality of the included studies as assessed by Grades of Recommendation, Assessment, Development and Evaluation criteria (58) was low for each of the primary outcomes ( (21,38,40,41) that used central randomization, not concealed in one trial that used hospital record numbers to allocate patients (37), and unspecified in two trials (39,42). The quality of the included studies as assessed by Grades of Recommendation, Assessment, Development and Evaluation criteria (58) was low for each of the primary outcomes ( (21,38,40,41) that used central randomization, not concealed in one trial that used hospital record numbers to allocate patients (37), and unspecified in two trials (39,42).…”