Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs.
While Patient Blood Management (PBM) is becoming a new standard worldwide with evidence-based and expert consensus guidelines to promote the three PBM pillars, measuring the performance of these efforts remains a challenge. PBM programmes need to measure transfusion reductions and patient-specific outcomes, and report these to drive change. Here is one such impactful report supporting […]
Obstetric intra-operative cell salvage: a review of an established cell salvage service with 1170 re-infused cases.
This is a retrospective report of 10 years of obstetrical cell salvage use in a single hospital. The authors report on 1170 patients who had a median of 231 mL of blood reinfused. This article contributes to the growing amount of information on the safety of cell salvage use in obstetrics. Over the 10 years of their study, […]
Multimodal patient blood management program based on a three-pillar strategy: a systematic review and meta-analysis.
This systematic review and meta-analysis focused on the implementation of a comprehensive PBM approach. Studies included had to address at least one recognised PBM modality per pillar. Data for 235,779 surgical patients were included (100,886 in the pre-PBM group and 134,893 in the PBM group). The combined PBM measures led to improved clinical outcomes through a reduction of […]
There is growing evidence that patient blood management (PBM) is becoming “standard of care” in major surgery associated with high blood loss, particularly in cardiac surgery. These guidelines are the result of the combined efforts of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA) in order to offer […]
The impact of a multidisciplinary blood conservation protocol on patient outcomes and cost after cardiac surgery.
This before-and-after study confirms that a standardised intraoperative blood conservation programme including expanded use of cell salvage, extensive adoption of acute isovolemic haemodilution and routine use of retrograde autologous priming is associated with a reduction in blood product transfusion and improved outcome. It is unfortunate that this programme did not include the detection and the […]
Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.
“Randomised controlled trials (RCTs) are the de facto standard for answering clinical questions, delivering the highest grade of evidence available.” What sounds logical at first sight for many scientific problems is debatable for many other clinical situations: whereas RCTs are designed to answer one specific question in a given set of patients by falsification of […]
How to cook a patient blood management programme! In this ‘position paper’, a group of well-known PBM experts offers us a how-to guide for those looking to implement PBM programmes. Over 6 years ago, the WHO urged its member states to implement PBM (decision WHA63.12), but it is easier said than done! “Cooking a good […]
Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis of randomized trials.
This meta-analysis, which includes 29 randomised controlled trials for a total of 2439 patients, evaluates the effectiveness of acute normovolemic haemodilution (ANH) to reduce the number of allogeneic red blood cell (RBC) units transfused in adult patients undergoing all types of cardiac surgery. Results from 21 studies were included in the analysis. Overall, ANH reduced the number of […]
Revisiting acute normovolemic hemodilution and blood transfusion during pediatric cardiac surgery: a prospective observational study.
Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at high risk of being exposed to relatively large volumes of allogeneic blood products. If blood transfusion can be life-saving in some circumstances (e.g. major haemodilution or massive haemorrhage), the administration of large volumes of allogeneic blood products has been shown to significantly increase the risk […]
Very low rate of patient-related adverse events associated with the use of intraoperative cell salvage.
This retrospective review confirms that the use of cell salvage intraoperatively is safe, with a rate of patient-related adverse event varying between 0 and 0.006%. Although this very low incidence of adverse events could certainly be related to the highly regulated environment in which cell salvage was performed, it might have been underestimated due to […]
Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA.
In the absence of large randomised trials, meta-analyses are a useful tool to assess whether a technique is clinically beneficial. This meta-analysis by Meybohm et al. provides further support to the importance of cell salvage as a part of a patient blood management strategy. Apart from the obvious reduction in the use of allogeneic blood, […]
Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study.
This article gives the results of an observational study that used a historical cohort of patients as a control group. This of course can cause a myriad of confounding issues. The topic, however, is of interest in those institutions that offer surgical operations to people who have a haemolytic anaemia. Many cell salvage guidelines warn […]
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 […]
Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management.
These Practice Guidelines update “Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies” adopted by the American Society of Anesthesiologists in 2005 and published in 2006. They provide new evidence obtained from the most recent scientific literature. […]
Teeztmann et al. conducted a randomised controlled study where 164 patients received either autologous salvaged blood collected using the Sangvia™ Blood Salvage System or allogeneic red cell concentrates if transfusion was indicated according to clinical judgment (there were not predefined transfusion criteria). No statistically significant difference in postoperative infection rate (primary outcome variable) was observed between […]