Haemoglobin Thresholds for Transfusion: How Are We Doing in the Era of Choosing Wisely? A Retrospective Cohort Study

April 7, 2024 No Comments

This retrospective cohort study examines red blood cell (RBC) transfusion practices at a Swiss university hospital from 2012 to 2019, in line with the Choosing Wisely initiative’s recommended haemoglobin thresholds. It reveals a trend towards more restrictive transfusion practices, with mean pretransfusion haemoglobin levels decreasing over the years. The study also found a significant reduction in potentially inadequate transfusions, indicating adherence to guidelines. Key risk factors for potentially inadequate transfusions include older age, surgical procedures, and chronic conditions. The increase in single RBC unit transfusions suggests a shift towards efficiency and caution in transfusion practices, aligning with the initiative’s goals to improve patient care and outcomes.

Preliminary Report of Extracorporeal Blood Purification Therapy in Patients Receiving LVAD: Cytosorb or Jafron HA330

April 4, 2024 No Comments

This study investigates the effects of extracorporeal blood purification therapy using Cytosorb and Jafron HA330 in patients undergoing Left Ventricular Assist Device (LVAD) implantation, aimed at mitigating immune dysregulation and infectious complications by reducing proinflammatory cytokine levels. Data from 15 patients receiving HeartMate 3™ LVADs were analyzed, with groups assigned to Cytosorb therapy, Jafron HA330, or control (usual care without filters). Results indicated that despite LVAD implantation increasing levels of various inflammatory markers, neither Cytosorb nor Jafron therapies had a significant impact on these markers, in-hospital mortality, or overall survival. The study suggests the need for larger, prospective studies to explore the potential benefits of hemoadsorption therapies in improving outcomes for LVAD patients.

Consensus of the Brazilian Association of Hematology, Hemotherapy, and Cellular Therapy on Patient Blood Management: Antifibrinolytics

April 3, 2024 No Comments

The article highlights the importance of antifibrinolytic drugs, such as epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA), in reducing blood loss and the need for transfusions in both cardiac and non-cardiac surgeries. These drugs are recognized for their effectiveness without causing significant adverse effects. EACA comes highly recommended for heart surgeries, with no substantial evidence of thrombotic potential, while TXA is noted for its safety and efficacy in reducing transfusion use, with precautions for dose adjustment in renal impairment and seizure risks at doses over 2 g per day.

A Comparison of the Clinical Outcomes of Minimum and Maximum Hematocrit Levels During Cardiopulmonary Bypass (CPB) in Low-risk Patients Undergoing Coronary Artery Bypass Graft Surgery (CABG): A Cross-sectional Study

March 27, 2024 No Comments

This cross-sectional study explores the clinical outcomes of minimum and maximum hematocrit (HCT) levels during cardiopulmonary bypass (CPB) in low-risk coronary artery bypass graft (CABG) surgery patients. It found that lower HCT levels (16-18%) resulted in significantly less post-surgery drainage and lower incidence of cognitive disorders compared to higher HCT levels (25-27%), which required more transfusions of packed red blood cells and fresh frozen plasma, leading to an increased risk of cognitive impairments.

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age

March 12, 2024 No Comments

This study investigates the effectiveness of Patient Blood Management (PBM) programs in older adults undergoing cardiovascular surgery, focusing on those aged 60 and above, including a detailed look at individuals 75 and older. The findings reveal significant reductions in red blood cell transfusion rates and mortality, alongside lower risks of adverse events post-PBM implementation, without any negative outcomes. Notably, the advantages of PBM were consistent across all age groups studied, indicating that even the oldest patients can benefit from tailored blood management strategies in cardiovascular procedures.

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.