Patient blood management in the cardiac surgical setting: An updated overview. (August 2019)

• Record Type: Journal Article
• Authors: Terwindt, L.E.; Karlas, A.A.; Eberl, S.; Wijnberge, M.; Driessen, A.H.G.; Veelo, D.P.; Geerts, B.F.; Hollmann, M.W.; Vlaar, A.P.J.
• Is Part Of: Transfusion and apheresis science. Volume 58:Number 4(2019)
• Page Start: 397
• Page End: 407
• Publication Date: 2019-08
• Subjects: ACT activated clotting time -- ASA acetylsalicylic acid -- AUC receiver operating characteristic curve -- COX1 cyclooxygenase-1 -- CPB cardiopulmonary bypass -- DAPT dual antiplatelet therapy -- DOAC's direct oral anticoagulant drugs -- Hb hemoglobin -- HRE human recombinant EPO -- LVBT large volume blood transfusion -- PBM patient blood management -- PCC prothrombin complex concentrates -- POCT point of care tests -- rFVIIa recombinant factor VIIa -- ROTEM thromboelastometry -- TACO transfusion associated circulatory overload -- TEG thromboelastography -- TRALI transfusion-related acute lung injury -- TXA2 thromboxane A2 -- TXa tranexamic acid -- VKA vitamin K antagonists; Anticoagulation -- Blood transfusion -- Cardiac surgery -- Coagulation factors -- Fibrinogen -- Hemostasis -- Point of care tests -- Prothrombin complex concentrates -- Transfusion thresholds; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2019.06.015
• Languages: English
• ISSNs: 1473-0502

Abstract

Abstract: In cardiac surgical patients it is a complex challenge to find the ideal balance between anticoagulation and hemostasis. Preoperative anemia and perioperative higher transfusion rates are related to increased morbidity and mortality. Patient blood management (PBM) is an evidence based patient specific individualized protocol used in the perioperative setting in order to reduce perioperative bleeding and transfusion rates and to improve patient outcomes. The three pillars of PBM in cardiac surgery consist of optimization of preoperative erythropoiesis and hemostasis, minimizing blood loss, and improving patient specific physiological reserves. This narrative review focuses on the challenges with special emphasis on PBM in the preoperative phase and intraoperative transfusion management and hemostasis in cardiac surgery patients. It is a "must" that PBM is a collaborative effort between anesthesiologists, surgeons, perfusionists, intensivists and transfusion laboratory teams. This review represents an up to date overview over "PBM in cardiac surgery patients".