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DOI: 10.1055/s-2001-18197
© Georg Thieme Verlag Stuttgart · New York
Multimodal Blood Sparing Concepts
Multimodale Blutsparende TherapiePublikationsverlauf
Publikationsdatum:
05. November 2001 (online)
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Infectious risks of transfusion, but also cost and resource efficiency considerations have triggered continuing efforts to reduce blood transfusion. Despite different national consensus guidelines, several American and European multicenter studies demonstrated a substantial variability in perioperative transfusion practice [1] [2] [3] [4] [5]. Even in a selected patient population at low risk for transfusion therapy, Stover et al demonstrated that the percentage of patients transfused and the median number of units transfused per patient varied considerably between institutions [3]. Evaluating blood products use in more than 40 teaching hospitals from 10 European countries, the SANGUIS study demonstrated that transfusion rates depend more on physicians than on type of procedure, patient population or hospital [4]. A recent study involving teaching and non-teaching hospitals found similar results [5]. Reasons for the large variability in transfusion practice remain elusive, but clinicians' practice and attitude may be entrenched and slow to change [6]. Application of a standardised multidisciplinary transfusion strategy might reduce the use of allogeneic blood transfusion in major surgical patients.
A multidisciplinary approach of blood transfusion strategy has been progressively developed in the department of cardiac surgery of our institution from 1997 [7]. The developed strategy involved a standardised blood conservation program and a multidisciplinary allogeneic blood transfusion policy. The transfusion trigger not only depended on the hemoglobin level, but also on the clinical status of the patient and on the relative risk of postoperative complications. All patients undergoing cardiac surgery over a two-year period were included. Procedures consisted of coronary artery revascularization, single or multiple valve replacement, and complex aortic operations. Emergency procedures were excluded. Data obtained in a first group including patients operated from September 97 to August 98 (group 1: N = 321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 98 to August 99 (group 2: N = 315) when the transfusion strategy was applied uniformly. Patient populations and surgical procedures were similar in both groups. The uniform application of the multidisciplinary blood transfusion strategy resulted in a 45 % reduction in the number of patients receiving allogeneic blood, and in a 53 % reduction in the number of allogeneic blood units transfused. These results were essentially related to a reduction in postoperative transfusion. Postoperative hemoglobin concentrations, mortality and morbidity were not different among groups.
Development of a standardized multidisciplinary approach to blood conservation markedly reduced the exposure of cardiac surgery patients to allogeneic blood. In view of these results, it might be suggested that the real efficacy of any novel blood conservation technique can only be evaluated when an institutional multidisciplinary approach of blood transfusion has been achieved previously.
References
- 1 Goodnough L T, Despotis G J, Hogue C W, Ferguson T BJ. On the need for improved transfusion indicators in cardiac surgery. Ann Thorac Surg. 1995; 60 473-480
- 2 Surgenor D M, Churchill W H, Wallace E L. et al . The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: a study of five hospitals. Transfusion. 1998; 38 122-134
- 3 Stover E P, Siegel L C, Parks R. et al . Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines. Anesthesiology. 1998; 88 327-333
- 4 Sirchia G, Giovanetti A M, McClelland D BL, Fracchia G N. Safe and good use of blood in surgery (SANGUIS). Use of blood products and artificial colloids in 43 European hospitals. European Commission, European Community, Brussels 1994
- 5 Baele P, Beguin C, Waterloos H. et al . The Belgium BIOMED Study about transfusion for surgery. Acta Anaesth Belg. 1998; 49 243-303
- 6 Salem-Schatz S R, Aworn J, Soumerai S B. Influence of clinical knowledge, organizational context and practice style on transfusion decision making: implications for practice change strategies. J Am Med Assoc. 1990; 264 476-483
- 7 Van der Linden P, De Hert S, Daper A, Trenchant A, Jacobs D, De Boelpaepe C, Kimbimbi P, Defrance P, Simoens G. A Standardised Multidisciplinary Approach Reduces the Use of Allogeneic Blood Products in Patients Undergoing Cardiac Surgery. Can J Anesth (in press).
Prof. Dr. Philippe Van der Linden
Service d' Anesthésie Cardiaque C.H.U. de Charleroi,
Espace Santé
Site de Jumet
73 rue de Gosselies
6040 Jumet, Belgien