Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Jacob Raphael, C. David Mazer, Sudhakar Subramani, Andrew Schroeder, Mohamed Abdalla, Renata Ferreira, Philip E. Roman, Nichlesh Patel, Ian Welsby, Philip E. Greilich, Reed Harvey, Marco Ranucci, Lori B. Heller, Christa Boer, Andrew Wilkey, Steven E. Hill, Gregory A. Nuttall, Raja R. Palvadi, Prakash A. Patel, Barbara WilkeyBrantley Gaitan, Shanna S. Hill, Jenny Kwak, John Klick, Bruce A. Bollen, Linda Shore-Lesserson, James Abernathy, Nanette Schwann, W. Travis Lau

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

Original languageEnglish (US)
Pages (from-to)2887-2899
Number of pages13
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume33
Issue number11
DOIs
StatePublished - Nov 2019
Externally publishedYes

Bibliographical note

Funding Information:
Philip Greilich, MD, recieved research funding from AMAG Pharmaceuticals (IV iron supplementation). C. David Mazer, MD, received research grants to institution and consulting honoraria from Allocure Inc, Amgen, Boehringer Ingelheim, CSL Behring, OctaPharma, Quark Pharmaceuticals, Tenax Therapeutics and Thrasos Innovation. Marco Ranucci, MD, received consultancy fees from Haemonetics and Medtronic; speaker's fees from Werfen, CSL Behring, Grifols; and research grants from Roche Diagnostics, Hemosonics, Werfen, and CSL Behring. Jacob Raphael, MD, received a research grant from OctaPharma. Ian Welsby, MBBS, received a research grant from CSL Behring.

Funding Information:
The Clinical Practice Improvement Subcommittee and the Blood Conservation Working Group dedicate this paper to William Travis Lau, MD. He was a physician dedicated to setting national standards and best practices for patient blood management in cardiac surgery. To all who knew him, he was a passionate physician and an exemplary human being. His life was tragically taken on January 28, 2019. The Society of Cardiovascular Anesthesiologists, his colleagues, and friends mourn a life cut short of its prime and maximum impact. ?And therefore never send to know for whom the bell tolls; it tolls for thee.? John Donne, Philip Greilich, MD, recieved research funding from AMAG Pharmaceuticals (IV iron supplementation). C. David Mazer, MD, received research grants to institution and consulting honoraria from Allocure Inc, Amgen, Boehringer Ingelheim, CSL Behring, OctaPharma, Quark Pharmaceuticals, Tenax Therapeutics and Thrasos Innovation. Marco Ranucci, MD, received consultancy fees from Haemonetics and Medtronic; speaker's fees from Werfen, CSL Behring, Grifols; and research grants from Roche Diagnostics, Hemosonics, Werfen, and CSL Behring. Jacob Raphael, MD, received a research grant from OctaPharma. Ian Welsby, MBBS, received a research grant from CSL Behring.

Publisher Copyright:
© 2019

Keywords

  • Transfusion
  • bleeding
  • cardiac anesthesia
  • cardiac surgery
  • hemostasis

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