Application of Simplified Blood Management in Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANGHuan-lei ¹ , XIEXu-jing ² ,  ZHANGJian-jun ¹ , LUCong ¹ , GUOXiao-gang ¹ , KEJun ¹ , LUOSha ¹ , XIONGWei-ping ¹ , CHENJi-mei ¹

1. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510100, P. R. China;
2. Department of Cardiology of The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P. R. China;

Corresponding author：

ZHANGJian-jun, Email: 13500002389@163.com

Keywords：

Simplification; Blood management; Transfusion; Cardiac surgery

DOI：

10.7507/1007-4848.20150250

Video：

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Objective To study the effectiveness of simplified blood management in cardiovascular surgery, minimize the need for blood transfusions and decrease the medical care costs. Methods From March 2010 to May 2013, the simplified blood management was applied in 655 patients who underwent cardiovascular surgery in the department of cardiac surgery, Guangdong General Hospital. There were 316 males and 339 females with their age of 13-78 (45.0±13.8) years. The techniques of simplified blood management consisted of preoperative strategies, intraoperative strategies, and postoperative strategies. Results There were 437 patients (66.7%) avoiding red cell transfusion in cardiac surgery. Of the 437 patients, 403 (61.5%) without any blood products transfusion, 29 had transfusion of plasma transfusion, 3 of plasma and cryoprecipitation, one of plasma and platelet, and one of platelet only. Two patients died within 30 days postoperative with 0.5% mortality rate:one died of multiple organ failure, one died of cardiac arrest. The procedures and special etiologies of 437 patients avoiding red cell transfusion included mitral valve replacement in 86 patients, double valve (aortic and mitral) replacement in 75 patients, aortic valve replacement in 51 patients, mitral valve replacement plus modified Maze procedure in 41 patients, atrial septal defect repair in 41 patients, mitral valve repair in 38 patients, double valve replacement plus modified Maze procedure in 25 patients, re-do operation in 23 patients, ventricular septal defect repair in 18 patients, coronary artery bypass grafting plus valve replacement in 10 patients, myxoma excision in 8 patients, subacute bacterial endocarditis in 8 patients, pericardium dissection in 5 patients, off-pump coronary artery bypass grafting in 4 patients, Bentall procedure in 4 patients. Of 65 patients with cardiac surgery history, 23 (35.4%) were free from red cell transfusion in the second operation. Conclusion Simplified blood management is of benefit to reduce the blood transfusion safely and effectively, no using additional expensive medication and medical devices and therefore without increasing hospital costs. The technique is suitable to any institute and patient. It is worthwhile to be used widely in clinical practice. Cell salvage system is not necessary.

Citation： HUANGHuan-lei, XIEXu-jing, ZHANGJian-jun, LUCong, GUOXiao-gang, KEJun, LUOSha, XIONGWei-ping, CHENJi-mei. Application of Simplified Blood Management in Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1000-1004. doi: 10.7507/1007-4848.20150250 Copy

1.	Rogers MA,Blumberg N,Saint S,et al.Hospital variation in transfusion and infection after cardiac surgery:a cohort study.BMC Med,2009,doi:10.1186/1741-7015-7-37.
2.	Yu PJ,Cassiere HA,Dellis SL,et al.Dose-dependent effects of intraoperative low volume red blood cell transfusions on postoperative outcomes in cardiac surgery patients.J Cardiothorac and Vasc Anesth,2014,http://dx.doi.org/10.1053/j.jvca.2014.05.025.
3.	Koch CG,Li L,Duncan AI,et al.Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.Crit Care Med,2006,34(6):1608-1616.
4.	Bohlius J,Weingart O,Trelle S,et al.Cancer-related anemia and recombinant human erythropoietin-an updated overview.Nat clin pract Oncol,2006,3(3):152-164.
5.	Varghese R,Myers ML.Blood conservation in cardiac surgery:Let's get restrictive.Semin Thoracic Surg,2010,22(2):121-126.
6.	Nobahar MR,Chegini A,Behnaz F.Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery.Saudi J Anesth,2014,8(3):342-344.
7.	黄焕雷,谢旭晶,卢聪,等.抑肽酶停用后再次开胸止血的临床分析及对策.实用医学杂志,2010,26(12):2173-2175.
8.	Ott DA,Cooley DA.Cardiovascular surgery in Jehovah's witnesses.Report of 542 operations without blood transfusion.JAMA,1977,238(12):1256-1258.
9.	Nalla BP,Freedman J,Hare GMT,et al.Update on blood conservation for cardiac surgery.J Cardiothorac Vasc Anesth,2012,26(1):117-133.
10.	Speiss BD.Transfusion and outcome in heart surgery.Ann Thorac Surg,2002,74(3):986-987.
11.	Wells AW,Mounter PJ,Chapman CE,et al.Where does blood go?Prospective observational study of red cell transfusion in north England.BMJ,2002,325(7368):803.
12.	Murphy GJ,Reeves BC,Rogers CA,et al.Increased mortality,postoperative morbidity,and cost after red blood cell transfusion in patients having cardiac surgery.Circulation,2007,116(22):2544-2552.
13.	Hébert PC,Wells G,Blajchman MA,et al.A multicenter,randomized,controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators,Canadian Critical Care Trials Group.N Engl J Med,1999,340(6):409-417.
14.	Horvath KA,Acker MA,Chang H,et al.Blood transfusion and infection after cardiac surgery.Ann Thorac Surg,2013,95(6):2194-2201.
15.	Dorneles Cde C,Bodanese LC,Guaragna JC,et al.The impact of blood transfusion on morbidity and mortality after cardiac surgery.Rev Bras Cir Cardiovasc,2011,26(2):222-229.
16.	Mohnle P,Snyder-Ramos SA,MiaoY,et al.Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients.Intensive Care Med,2011,37(1):97-109.
17.	Mariscalcoa G,Biancarib F,Juvonenb T,et al.Red blood cell transfusion is a determinant of neurological complications after cardiac surgery.Interact CardioVasc Thorac Surg,2014,doi:10.1093/icvts/ivu360.
18.	Paone G,Likosky DS,Brewer R,et al.Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality.Ann Thorac Surg,2014,97(1):87-93.
19.	Haanschoten MC,van Straten AH,Verstappen F,et al.Reducing the immediate availability of red blood cells in cardiac surgery,a single-centre experience.Neth Heart J,DOI 10.1007/s12471-014-0618-9.
20.	Stover EP,Siegel LC,Parks R,et al.Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:a 24-institution study.Institutions of the Multicenter Study of Perioperative Ischemia Research Group.Anesthesiology,1998,88(2):327-333.
21.	DeFoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting.Northern New England Cardiovascular Disease Study Group.Ann Thorac Surg,2001,71(3):769-776.
22.	Karkouti K,Djaiani G,Borger MA,et al.Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery.Ann Thorac Surg,2005,80(4):1381-1387.
23.	Weiskopf RB,Feiner J,Hopf H,et al.Fresh blood and aged stored blood are equally efficacious in immediately reversing anemiainduced brain oxygenation deficits in humans.Anesthesiology,2006,104(5):911-920.
24.	Jakobsen CJ.Transfusion Strategy:Impact of haemodynamics and the challenge of haemodilution.J Blood Transfus,2014,http://dx.doi.org/10.1155/2014/627141.
25.	张卫.输血与围术期血液管理.实用医院临床杂志,2014,11(3):6-8.

1. Rogers MA,Blumberg N,Saint S,et al.Hospital variation in transfusion and infection after cardiac surgery:a cohort study.BMC Med,2009,doi:10.1186/1741-7015-7-37.
2. Yu PJ,Cassiere HA,Dellis SL,et al.Dose-dependent effects of intraoperative low volume red blood cell transfusions on postoperative outcomes in cardiac surgery patients.J Cardiothorac and Vasc Anesth,2014,http://dx.doi.org/10.1053/j.jvca.2014.05.025.
3. Koch CG,Li L,Duncan AI,et al.Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.Crit Care Med,2006,34(6):1608-1616.
4. Bohlius J,Weingart O,Trelle S,et al.Cancer-related anemia and recombinant human erythropoietin-an updated overview.Nat clin pract Oncol,2006,3(3):152-164.
5. Varghese R,Myers ML.Blood conservation in cardiac surgery:Let's get restrictive.Semin Thoracic Surg,2010,22(2):121-126.
6. Nobahar MR,Chegini A,Behnaz F.Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery.Saudi J Anesth,2014,8(3):342-344.
7. 黄焕雷,谢旭晶,卢聪,等.抑肽酶停用后再次开胸止血的临床分析及对策.实用医学杂志,2010,26(12):2173-2175.
8. Ott DA,Cooley DA.Cardiovascular surgery in Jehovah's witnesses.Report of 542 operations without blood transfusion.JAMA,1977,238(12):1256-1258.
9. Nalla BP,Freedman J,Hare GMT,et al.Update on blood conservation for cardiac surgery.J Cardiothorac Vasc Anesth,2012,26(1):117-133.
10. Speiss BD.Transfusion and outcome in heart surgery.Ann Thorac Surg,2002,74(3):986-987.
11. Wells AW,Mounter PJ,Chapman CE,et al.Where does blood go?Prospective observational study of red cell transfusion in north England.BMJ,2002,325(7368):803.
12. Murphy GJ,Reeves BC,Rogers CA,et al.Increased mortality,postoperative morbidity,and cost after red blood cell transfusion in patients having cardiac surgery.Circulation,2007,116(22):2544-2552.
13. Hébert PC,Wells G,Blajchman MA,et al.A multicenter,randomized,controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators,Canadian Critical Care Trials Group.N Engl J Med,1999,340(6):409-417.
14. Horvath KA,Acker MA,Chang H,et al.Blood transfusion and infection after cardiac surgery.Ann Thorac Surg,2013,95(6):2194-2201.
15. Dorneles Cde C,Bodanese LC,Guaragna JC,et al.The impact of blood transfusion on morbidity and mortality after cardiac surgery.Rev Bras Cir Cardiovasc,2011,26(2):222-229.
16. Mohnle P,Snyder-Ramos SA,MiaoY,et al.Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients.Intensive Care Med,2011,37(1):97-109.
17. Mariscalcoa G,Biancarib F,Juvonenb T,et al.Red blood cell transfusion is a determinant of neurological complications after cardiac surgery.Interact CardioVasc Thorac Surg,2014,doi:10.1093/icvts/ivu360.
18. Paone G,Likosky DS,Brewer R,et al.Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality.Ann Thorac Surg,2014,97(1):87-93.
19. Haanschoten MC,van Straten AH,Verstappen F,et al.Reducing the immediate availability of red blood cells in cardiac surgery,a single-centre experience.Neth Heart J,DOI 10.1007/s12471-014-0618-9.
20. Stover EP,Siegel LC,Parks R,et al.Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:a 24-institution study.Institutions of the Multicenter Study of Perioperative Ischemia Research Group.Anesthesiology,1998,88(2):327-333.
21. DeFoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting.Northern New England Cardiovascular Disease Study Group.Ann Thorac Surg,2001,71(3):769-776.
22. Karkouti K,Djaiani G,Borger MA,et al.Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery.Ann Thorac Surg,2005,80(4):1381-1387.
23. Weiskopf RB,Feiner J,Hopf H,et al.Fresh blood and aged stored blood are equally efficacious in immediately reversing anemiainduced brain oxygenation deficits in humans.Anesthesiology,2006,104(5):911-920.
24. Jakobsen CJ.Transfusion Strategy:Impact of haemodynamics and the challenge of haemodilution.J Blood Transfus,2014,http://dx.doi.org/10.1155/2014/627141.
25. 张卫.输血与围术期血液管理.实用医院临床杂志,2014,11(3):6-8.

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