Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery.

“Too good to be true” might be one of the first thoughts emerging after one has read the article by LaPar and coworkers. On a first view the authors succeeded in demonstrating that initiation of a multi-institutional transfusion guideline not only reduces blood use in cardiac surgery, but also results in an improvement of mortality, morbidity and transfusion associated costs. They were able to demonstrate that a concerted action of many centers to reduce unnecessary blood transfusions can induce a behavioral change that results in a real change in patient outcome.

However, some questions remain open: What are the measures that were actually initiated in every hospital? What was the role of time, since a simultaneous control group is missing? Are the differences observed of biological importance or just of statistical significance?

Despite these weak points, the data presented convincingly demonstrate that initiation of a modern patient blood management program is well worth the effort.

– Jens Meier