The Perfusionist’s Role in a Collaborative Multidisciplinary Approach to Blood Transfusion Reduction in Cardiac Surgery

Zelinka, Edy S.; Brevig, James; McDonald, Julie; Jin, Ruyun

doi:10.1051/ject/201042045

Cited by 7 publications

(1 citation statement)

References 10 publications

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“…Their retrospective study of 2979 consecutive cardiac surgical patients showed a reduction in red cell transfusions from 43-13.6% for all patients and 38.5-8.7% for coronary artery bypass patients. The authors noted that their first step was to achieve standardization among the perfusion team for a successful blood conservation program (15).…”

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confidence: 99%

The Team Focus on Improving Blood Transfusion

McMillan,

Brady,

Foot

et al. 2011

J Extra Corpor Technol

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The current literature pertaining to associated morbidity and mortality with homologous blood transfusion in the surgical patient seems to be pointing only in one direction, which is we must start reducing our patients exposure to homologous blood and products. There appears to be ever mounting evidence of increases in infraction, stroke, transfusion related lung injury, infection, and death that authors are associating with transfusion. A number of authors are reporting success in reducing their patients’ requirements for homologous transfusion simply by working as a team or what is known as a multidisciplinary approach and following set transfusion protocols and algorithms. At our institution we have taken note of these reports and have taken the first steps in the formation of a Cardiac Surgical Transfusion Management Group where all specialties involved in the decision making process of transfusion in the cardiac surgical patient can have representation and be directly involved in the establishment of protocols, transfusion algorithms, and a transfusion audit system. The main goal of this group is to implement a change in transfusion practice and to assess the impact the change has had on transfusion requirements and make appropriate recommendations to the treating specialists.

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mentioning

confidence: 99%

The Team Focus on Improving Blood Transfusion

McMillan,

Brady,

Foot

et al. 2011

J Extra Corpor Technol

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Iatrogenic Blood Loss

2012

Basics of Blood Management

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The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Stammers¹,

Francis²,

Tesdahl³

et al. 2019

J Extra Corpor Technol

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Autologous priming (AP) of the extracorporeal circuit has been used as a technique to reduce iatrogenic anemia in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to review the results of standardizing AP techniques to reduce variation among clinicians and its effect on clinical outcomes. Standardized goal-directed protocols for AP were established by the cardiac team and applied to all adult cardiac surgical patients where CPB was used. Following Institutional Review Board approval, data were analyzed for two sequential groups of patients: Non-standardized AP (NST-AP) and standardized AP (ST-AP). Exclusion criteria included pre-CPB hemodynamic instability and preoperative hematocrit (Hct) values less than 30%. The primary end point was the transfusion of red blood cells (RBCs), whereas secondary end points included Hct change and other perioperative allogeneic blood product transfusions. Data are presented as mean and SD. Of the 192 patients evaluated, 82 were in the NST-AP group and 110 in the ST-AP group. There were no preoperative demographic differences across groups. Total AP volume was lower in the NST-AP group than in the ST-AP patients (486.8 ± 259.6 mL vs. 1,048.2 ± 218.7 mL, p < .001). Whereas pre-CPB Hct values were identical between the groups, the first on-CPB (25.7% ± 4.5% vs. 27.9% ± 4.2%, p < .001), high CPB (27.7% ± 3.5% vs. 29.1% ± 3.6%, p < .008), and first postoperative (32.5% ± 4.0% vs. 34.3% ± 3.9%, p < .003) were all significantly higher in ST-AP patients. Perioperative transfusion rate was higher in NST-AP patients (63.6%) vs. ST-AP (44.6%), p < .01. There was no difference in intraoperative RBC transfusion, but postoperatively, more patients in the NST-AP group received RBCs than those in the ST-AP group (51.2% vs. 28.2%, p < .01). The application of an ST-AP protocol was effective in reducing hemodilution, which was associated within higher Hcts and lower postoperative transfusion rates.

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The Perfusionist’s Role in a Collaborative Multidisciplinary Approach to Blood Transfusion Reduction in Cardiac Surgery

Cited by 7 publications

References 10 publications

The Team Focus on Improving Blood Transfusion

The Team Focus on Improving Blood Transfusion

Iatrogenic Blood Loss

The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

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