“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