New guidelines for blood conservation during cardiac procedures

A team of medical experts led by a Virginia Commonwealth University anesthesiologist and a thoracic surgeon from the University of Kentucky has established a set of clinical guidelines to help physicians decrease the need for blood transfusions in high-risk patients during cardiac operations.

The team, led by Bruce Spiess, M.D., professor in the Department of Anesthesiology at the VCU School of Medicine and director of VCURES Shock Research Center, and Victor A. Ferraris, M.D., chief of the Division of Cardiothoracic Surgery at the University of Kentucky's Albert B. Chandler Hospital, developed the guidelines, "Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery." It appears as a standalone supplement to the May 2007 issue of the The Annals of Thoracic Surgery.

"Blood must be viewed as a scarce resource that carries risks and benefits," said Spiess. "This is a huge event for medicine. If these guidelines are adopted by a majority of cardiovascular centers in the world, we can decrease the amount of blood transfusions, blood usage and cost and blood shortages would be less frequent and not occur to such a degree.

"There is very strong evidence that patients who receive more blood have more post operative infection, have more renal failure and have more lung dysfunction," he said.

According to the report, about 15 to 20 percent of patients undergoing cardiac procedures consume more than 80 percent of the blood products transfused at operation.

Ferraris agreed with the great significance of the guidelines.

"The blood conservation practice guidelines generated under the auspices of the Society of Thoracic Surgeons represents a landmark undertaking," he said. "This work should serve as a template for individual cardiothoracic surgeons and for institutions as they manage valuable and scarce blood component resources."

In the analysis, the committees from the Society of Thoracic Surgeons, chaired by Ferraris, and the Society of Cardiovascular Anesthesiologists' Task Force on Blood Transfusion, chaired by Spiess, collaborated over a period of four years in determining the evidence-based series of recommendation for practice.

They reviewed all available published evidence related to blood conservation during cardiac operations and identified preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion.

The guidelines suggest that institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset.

Some evidence-based blood conservation techniques include drugs that increase preoperative blood volume or decrease postoperative bleeding; devices that conserve blood; and interventions that protect the patient's own blood from the stress of operation.

"We already do most or all of these things here at the VCU Medical Center and have led the nation in implementing an entire program," said Spiess. "We have not only been successful in cardiac surgery but also now have a full program for the whole hospital."


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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