Patient blood management in cardiac surgery results in fewer transfusions and better outcome.
Gross et al. compared transfusion and clinical data between the period prior to implementing patient blood management (PBM) (2006–2007) and after implementation of a PBM programme (2007–2012). The study suffers from several biases, particularly those of time and of the major imbalance between groups. Thus, I think it is difficult to draw strong conclusions on the clinical benefits of the authors’ PBM programme, e.g. a decrease in postoperative kidney injury and length of stay.
However, the article provides an interesting perspective to clinicians who wish to implement PBM in their hospital. As in many institutions, because of organisational issues, the authors were unable to implement the first pillar of PBM (detection and treatment of anaemia). Nonetheless, they show that it is possible to decrease the number of transfusions by implementing intra- and postoperative measures such as meticulous surgical technique, a goal-directed coagulation algorithm and a more restrictive transfusion threshold.
The message is important: one should strive to implement immediately all measures that can be implemented, while working on those that are more difficult to organise.
– Jean-François Hardy