Advancing Cardiotomy Suction Practices for Coronary Surgery via Multidisciplinary Collaborative Learning

March 3, 2024 No Comments

This study evaluates a quality-improvement intervention aimed at standardizing cardiotomy suction practices during coronary artery bypass grafting (CABG), promoting cessation before protamine administration. Involving 32 Michigan centers and comparing with four non-Michigan centers, the intervention included surgeon and perfusionist feedback, lectures, and evaluating change barriers. Results showed an 80.7% adherence to the practice among Michigan patients, with significant improvements post-intervention without negative clinical outcomes. This underscores the effectiveness of multidisciplinary collaboration in enhancing cardiotomy suction practices and patient care during CABG.

Contributing Factors to Heparin Resistance During Cardiopulmonary Bypass

February 20, 2024 No Comments

This study delves into heparin resistance (HR) during cardiopulmonary bypass (CPB) surgeries, analyzing 371 patients to identify contributing factors. HR, defined as the inability to achieve an activated clotting time of >480 seconds with an initial unfractionated heparin dose, was observed in 9.7% of cases. Key findings include the significant association of preoperative use of unfractionated heparin, certain blood parameters (e.g., white blood cell counts, fibrinogen levels), and notably, albumin and fibrinogen as independent predictors for HR. The research highlights the need for precise preoperative assessments to mitigate HR risks in CPB.

Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

February 17, 2024 No Comments

This article reviews randomized controlled trials and prospective studies comparing individualized heparin and protamine dosing based on real-time blood heparin concentration versus traditional total body weight methods during cardiopulmonary bypass (CPB). Meta-analysis shows that individualized dosing significantly reduces postoperative blood loss, improves protamine-to-heparin ratios, and increases early postoperative platelet counts. These findings suggest that precision in heparin and protamine dosing could decrease bleeding and transfusion needs, highlighting the potential of machine learning for future advancements in anticoagulation management for CPB.

Preoperative Anemia and Postoperative Outcomes in Cardiac Surgery: A Mediation Analysis Evaluating Intraoperative Transfusion Exposures

February 11, 2024 No Comments

This study investigates the impact of preoperative anemia on postoperative outcomes in cardiac surgery, particularly focusing on acute kidney injury (AKI) and hospital stay duration. Analyzing over 4,000 patients, the findings reveal that preoperative anemia significantly increases the risk of AKI and extends hospital stays, with a notable portion of these effects directly attributed to anemia rather than mediated through intraoperative red blood cell transfusions. The research underscores the need for further exploration into anemia’s role in postoperative complications and highlights the importance of addressing preoperative anemia in cardiac surgery patients.

Protamine Dosing and Its Impact in Cardiac Surgery Transfusion Practice: A Retrospective Bi-institutional Analysis

February 5, 2024 No Comments

This study investigates the correlation between protamine dosing and transfusion requirements in cardiac surgery, analyzing data from 762 patients who underwent cardiopulmonary bypass (CPB)-assisted cardiac surgery across two institutions. Patients were categorized into low-ratio (Protamine: UFH ≤ 0.8) and high-ratio (Protamine: UFH > 0.8) groups, based on the amount of protamine used to neutralize unfractionated heparin. Results indicated a significant increase in blood transfusion requirements in the high-ratio group, encompassing red blood cells, plasma, platelets, and cryoprecipitate, highlighting the need for precise protamine dosing to reduce bleeding and transfusion rates post-surgery.

Development and Validation of a Machine Learning Method to Predict Intraoperative Red Blood Cell Transfusions in Cardiothoracic Surgery

February 4, 2024 No Comments

A novel machine learning (ML) method has been developed to predict red blood cell (RBC) transfusion requirements in cardiothoracic surgery, enhancing blood inventory management and preoperative hemorrhage risk assessment. Utilizing data from 2410 surgeries between May 2014 and June 2019, with an additional 437 cases for validation, this method employs a hybrid approach combining Gaussian Process regression and classification algorithms. The model accurately predicts both minor (0 to 3 units) and significant (4+ units) RBC transfusions, showing promise for integrating ML into surgical planning and patient care optimization.

Association between Intraoperative Blood Salvage and Coagulation Disorder after Cardiopulmonary Bypass

February 4, 2024 No Comments

This study assesses the relationship between intraoperative blood salvage and coagulation disorders following cardiopulmonary bypass (CPB), using conventional coagulation tests and thromboelastography (TEG). Enrolling 92 patients undergoing cardiovascular surgery with CPB, it explored coagulation function in scenarios with and without cell salvage blood transfusion. Despite 57.6% of patients receiving cell salvage, the occurrence of coagulation disorders post-CPB showed no significant difference between groups, indicating that intraoperative blood salvage does not significantly impact coagulation disorder risk as diagnosed by TEG or conventional tests.

Low-Volume Acute Normovolemic Hemodilution Does Not Reduce Allogeneic Red Blood Cell Transfusion in Cardiac Surgery in the Modern Era of Patient Blood Management: A Propensity Score-Matched Cohort Study

February 2, 2024 No Comments

In a retrospective cohort study of 542 elective cardiac surgery patients, acute normovolemic hemodilution (ANH) did not significantly reduce perioperative red blood cell transfusion rates compared to controls. This suggests that in the context of modern patient blood management practices, the benefits of ANH in minimizing transfusion requirements may be less significant than previously thought.

Effects of Albumin and Crystalloid Priming Strategies on Red Blood Cell Transfusions in On-Pump Cardiac Surgery: A Network Meta-Analysis

January 20, 2024 No Comments

In on-pump cardiac surgery, a network meta-analysis revealed that crystalloid priming strategies are associated with fewer perioperative red blood cell (RBC) transfusions compared to albumin priming, although the difference in postoperative blood loss between the two was not statistically significant. The study suggests that while albumin priming might reduce postoperative blood loss, its use leads to more RBC transfusions and a higher blood management burden, indicating the need for careful consideration of its application in this context.

Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia

January 16, 2024 No Comments

The study investigated the use of procoagulant factors during heart transplants in Virginia and their potential link to postoperative thrombosis. It found a decrease in the use of off-label recombinant activated factor VII (rFVIIa) but an increase in off-label prothrombin complex concentrate (PCC) use, with rFVIIa associated with a higher risk of thrombosis, although patients receiving it were more critically ill, which may have influenced the results.

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Advancing Cardiotomy Suction Practices for Coronary Surgery via Multidisciplinary Collaborative Learning

Contributing Factors to Heparin Resistance During Cardiopulmonary Bypass

Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

Preoperative Anemia and Postoperative Outcomes in Cardiac Surgery: A Mediation Analysis Evaluating Intraoperative Transfusion Exposures

Protamine Dosing and Its Impact in Cardiac Surgery Transfusion Practice: A Retrospective Bi-institutional Analysis

Development and Validation of a Machine Learning Method to Predict Intraoperative Red Blood Cell Transfusions in Cardiothoracic Surgery

Association between Intraoperative Blood Salvage and Coagulation Disorder after Cardiopulmonary Bypass

Low-Volume Acute Normovolemic Hemodilution Does Not Reduce Allogeneic Red Blood Cell Transfusion in Cardiac Surgery in the Modern Era of Patient Blood Management: A Propensity Score-Matched Cohort Study

Effects of Albumin and Crystalloid Priming Strategies on Red Blood Cell Transfusions in On-Pump Cardiac Surgery: A Network Meta-Analysis

Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia

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