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J Cardiothorac Vasc Anesth. 2019 Nov;33(11):2887-2899. doi: 10.1053/j.jvca.2019.04.003. Epub 2019 Apr 19.

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.

Author information

1
University of Virginia Health System, Charlottesville, VA. Electronic address: Jr5ef@virginia.edu.
2
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
3
University of Iowa, Iowa City, IA.
4
University of Wisconsin Medical Center, Madison, WI.
5
Cleveland Clinic, Cleveland, OH.
6
University of Washington Medical Center, Seattle, WA.
7
Centura St. Anthony Hospital, Lakewood, CO.
8
University of California San Francisco, San Francisco, CA.
9
Duke University Hospital, Durham, NC.
10
UT Southwestern Medical Center, Dallas, TX.
11
UCLA Medical Center, Los Angeles, CA.
12
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
13
Swedish Medical Center, Seattle, WA.
14
VU University Medical Center, Amsterdam, Netherlands.
15
Abbott Northwestern Hospital, Minneapolis, MN.
16
Mayo Clinic, Rochester, MN.
17
Baylor College of Medicine, Houston, TX.
18
University of Pennsylvania Medical Center, Philadelphia, PA.
19
University of Colorado, Denver, CO.
20
Mayo Clinic, Phoenix, AZ.
21
Weill Cornell Medical Center, New York, NY.
22
Loyola University Medical Center, Maywood, IL.
23
Case Western University Medical Center, Cleveland, OH.
24
Missoula Anesthesiology, Missoula, MT.
25
Zucker School of Medicine at Hofstra/Northwell, Northshore University Hospital, Manhasset, New York, NY.
26
Johns Hopkins Medical Center, Baltimore, MD.
27
Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Tampa, FL; AAA Anesthesia Associates, Phymed Healthcare Group, Allentown, PA.
28
Pacific Anesthesia, Honolulu, HI.

Abstract

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

KEYWORDS:

Transfusion; bleeding; cardiac anesthesia; cardiac surgery; hemostasis

PMID:
31604540
DOI:
10.1053/j.jvca.2019.04.003

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