Measures of blood conservation should be undertaken, including retrograde autologous priming of cardiopulmonary bypass circuit
WEDNESDAY, June 30, 2021 (HealthDay News) — In a clinical practice guideline update, published online June 30 in the Annals of Thoracic Surgery, recommendations are presented for patient blood management during cardiothoracic surgery.
In collaboration with the Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, the American Society of Extracorporeal Technology, and the Society for the Advancement of Patient Blood Management, Pierre R. Tibi, M.D., from the Yavapai Regional Medical Center in Prescott, Arizona, and colleagues developed updated recommendations on patient blood management during cardiothoracic surgery.
The current recommendations include preoperative identification of high-risk patients; measures of blood conservation should be undertaken in this group. Risk assessment for anemia and determination of its etiology should be performed in all patients undergoing cardiac surgery. Standardized transfusion protocols should be implemented to reduce transfusion burden in patients undergoing cardiac surgery. Synthetic antifibrinolytic agents reduce blood loss and blood transfusion during cardiac procedures and are indicated for blood conservation. During off-pump coronary artery bypass graft surgery, tranexamic acid reduces bleeding and total transfusion. After cardiopulmonary bypass (CPB), topical application of antifibrinolytic agents to the surgical site can limit chest tube drainage and transfusion requirements after cardiac surgery using CPB. Retrograde autologous priming of the CPB circuit should be used where possible; reduced priming volume reduces hemodilution and is indicated for blood conservation. To reduce bleeding and transfusion, acute normovolemic hemodilution is reasonable. Administration of human albumin after cardiac surgery is reasonable to provide intravascular volume replacement and minimize transfusion requirement.
“Blood transfusions can be harmful to the body,” Tibi said in a statement. “Therefore, unless the proven benefit of blood transfusions outweighs the known risks, it is better to treat patients before, during, and after surgery in ways that decrease the risks of needing blood as much as possible for the best outcomes.”
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