Patient Blood Management in Cardiac Surgery
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Purpose of the Review
Recently, several large randomized studies and recommendations regarding patient blood management (PBM) in cardiac surgery were published. This review summarizes the current evidence relating to modern strategies in PBM from the perspective of the cardiovascular anesthesiologist.
Preoperative anemia should be early detected and adequately managed. In patients with intake of anticoagulants or platelet inhibitors, timely and specific stopping should be respected. Specific modification of cardiopulmonary bypass (CPB) systems aiming to reduce hemodilution and conserve patients’ blood reserve have been described. In combination with the use of cell-saving systems, such modifications might reduce the need for blood transfusion. Applying the restrictive transfusion thresholds for red blood cells (hemoglobin threshold close to 70 g/L) is not inferior to a liberal strategy (threshold close to 100 g/L) regarding 30-day mortality, and important outcomes including myocardial infarction, stroke, renal failure, infections, or arrhythmia. Finally, timely diagnosis and adequate treatment of hemostatic abnormalities by specific procoagulant interventions should be considered.
To optimize the risk-benefit ratio of allogeneic blood transfusion and to reduce associated costs, the implementation of PBM programs compromising a multidisciplinary and multifactorial approach including interventions before, during, and after surgery is suggested.
KeywordsTransfusion Blood Patient blood management Cardiac surgery
Compliance with Ethical Standards
Conflict of Interest
Daniel Bolliger, Andreas Buser, and Joachim M. Erb declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any unpublished studies or data with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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