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Torregrossa G, Sá MP, Van den Eynde J, Malin JH, Dokollari A, Erten O, Sun T, Sicouri S, Wertan MC, Ramlawi B, Sutter FP. Robotic-assisted versus conventional off-pump coronary surgery in women: A propensity-matched study. J Card Surg 2022; 37:3525-3535. [PMID: 35998275 DOI: 10.1111/jocs.16878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Off-pump coronary artery bypass (OPCAB) previously demonstrated its potential benefits in women; however, robotic-assisted OPCAB was scarcely studied. OBJECTIVES To investigate whether robotic-assisted OPCAB could further improve the outcomes in women and the potential impact of hybrid approaches with stents and completeness of revascularization on the late outcomes. METHODS Women who underwent robotic-assisted or conventional OPCAB (with sternotomy) between May 2005 and January 2021 at Lankenau Heart Institute were included. Propensity score matching was used to match 273 pairs on 27 characteristics. RESULTS In the intraoperative period, women who underwent robotic-assisted OPCAB presented longer operative times (6.00 vs. 5.38 h; p < 0.001), higher rates of extubation in the operating room (83.9% vs. 75.5%; p = 0.019) and lower rates of blood transfusion (13.2% vs. 32.2%; p < 0.001). In the postoperative period, women who underwent robotic-assisted OPCAB presented lower rates of new onset atrial fibrillation (16.8% vs. 25.6%; p = 0.016), need of blood transfusion (33.0% vs. 54.9%; p < 0.001), shorter intensive care unit (ICU) (46.1 vs. 49.8 h; p = 0.006) and hospital length of stay (5.0 vs. 6.0 days; p < 0.001). We observed no statistically significant differences in the rates of operative death between the groups (1.47% vs. 1.47%; p = 0.771). In the follow-up, we observed no differences in terms of overall survival regardless of hybrid procedures with stents and completeness of revascularization. CONCLUSIONS Robotic-assisted OPCAB in women is as safe as conventional OPCAB and may further improve outcomes. Hybrid coronary revascularization was a valuable adjunct in the robotic scenario and completeness of revascularization did not play a role in this setting.
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Affiliation(s)
- Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | | | - John H Malin
- Department of Cardiac Surgery, Philadelphia College of Osteopathic Medicine, Bala Cynwyd, Pennsylvania, USA
| | - Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Ozgun Erten
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Tian Sun
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - MaryAnn C Wertan
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Francis P Sutter
- Department of Cardiac Surgery, Lankenau Medical Center, Main Line Health, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
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Torregrossa G, Sá MP, Van den Eynde J, Malin JH, Sicouri S, Wertan MC, Ramlawi B, Sutter FP. Hybrid robotic off‐pump versus conventional on‐pump and off‐pump coronary artery bypass graft surgery in women. J Card Surg 2022; 37:895-905. [DOI: 10.1111/jocs.16247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Gianluca Torregrossa
- Department of Cardiac Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiac Surgery Research Lankenau Institute for Medical Research, Main Line Health Wynnewood Pennsylvania USA
| | - Michel Pompeu Sá
- Department of Cardiac Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiac Surgery Research Lankenau Institute for Medical Research, Main Line Health Wynnewood Pennsylvania USA
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences Katholieke Universiteit Leuven Leuven Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine Baltimore Maryland USA
| | - John H. Malin
- Philadelphia College of Osteopathic Medicine Bala Cynwyd Pennsylvania USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research Lankenau Institute for Medical Research, Main Line Health Wynnewood Pennsylvania USA
| | - MaryAnn C. Wertan
- Department of Cardiac Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood Pennsylvania USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiac Surgery Research Lankenau Institute for Medical Research, Main Line Health Wynnewood Pennsylvania USA
| | - Francis P. Sutter
- Department of Cardiac Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood Pennsylvania USA
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3
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Torregrossa G, Sá MP, Van den Eynde J, Sicouri S, Wertan MC, Ramlawi B, Sutter FP. Robotic hybrid coronary revascularization versus conventional off-pump coronary bypass surgery in women with two-vessel disease. J Card Surg 2021; 37:501-511. [PMID: 34811803 DOI: 10.1111/jocs.16146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) treats coronary artery disease (CAD) by combining a minimally invasive surgical approach with the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and percutaneous coronary intervention (PCI) for non-LAD vessels. This study aimed to compare immediate and long-term outcomes between robotic HCR and off-pump coronary artery bypass (OPCAB) via sternotomy in women with two-vessel CAD. METHODS AND RESULTS We compared all robotic HCR (LIMA-to-LAD plus stent; n = 55) and OPCAB (LIMA-to-LAD plus saphenous vein graft; n = 54) performed at a single institution between May 2005 and January 2021. To adjust for the selection bias of receiving either HCR or OPCAB, we performed a propensity score analysis of 31 matched pairs. In the immediate postoperative period, no statistically significant difference was observed for operative mortality and HCR was associated with lower rates of blood transfusion (25.8% vs. 54.8%; p = .038), and shorter hospital length of stay (4.0 vs. 6.0 days; p = .009). After a mean follow-up of 7.0 ± 4.9 years, we observed no statistically significant differences between the groups for overall survival (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.09-2.64, p = .401), myocardial infarction (HR: 1.60, 95% CI: 0.14-17.64, p = .703), stroke (HR not assessable; almost zero events), target vessel revascularization (HR: 0.45, 95% CI: 0.08-2.47, p = .359), angina (HR: 0.64, 95% CI: 0.20-2.01, p = .444) and major adverse cardiac and cerebrovascular events (HR: 0.46, 95% CI: 0.14-1.52, p = .202). CONCLUSIONS Robotic HCR provides for women with two-vessel CAD a shorter postoperative recovery with fewer blood transfusions, with similar long-term outcomes when compared with conventional OPCAB via sternotomy.
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Affiliation(s)
- Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - MaryAnn C Wertan
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Francis P Sutter
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
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Restrictive transfusion targets the heart now! Insight from the REALITY study. Anaesth Crit Care Pain Med 2021; 40:100854. [PMID: 33781988 DOI: 10.1016/j.accpm.2021.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ward AF, Lee R. Commentary: Why do coronary artery bypass grafting transfusion rates vary? We still don't know. J Thorac Cardiovasc Surg 2020; 163:1028-1029. [PMID: 32763035 DOI: 10.1016/j.jtcvs.2020.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Alison F Ward
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga
| | - Richard Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga.
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Fitzgerald DC, Simpson AN, Baker RA, Wu X, Zhang M, Thompson MP, Paone G, Delucia A, Likosky DS. Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2020; 163:1015-1024.e1. [PMID: 32631660 DOI: 10.1016/j.jtcvs.2020.04.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting surgery. METHODS Observational cohort study using the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 1, 2011, to July 1, 2017. Iterative multilevel logistic regression models were constructed using patient demographic characteristics, preoperative risk factors, and intraoperative conservation strategies to progressively explain center-level transfusion variation. RESULTS Of the 22,272 adult patients undergoing isolated coronary artery bypass surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells (range, 10.9%-59.9%). When compared with patients who were not transfused, patients who received at least 1 U red blood cells were older (68 vs 64 years; P < .001), were women (41.5% vs 15.9%; P < .001), and had a lower body surface area (1.93 m2 vs 2.07 m2; P < .001), respectively. Among the models explaining center-level transfusion variability, the intraclass correlation coefficients were 0.07 for model 1 (random intercepts), 0.12 for model 2 (patient factors), 0.14 for model 3 (intraoperative factors), and 0.11 for model 4 (combined). The coefficient of variation for center-level transfusion rates were 0.31, 0.29, 0.40, and 0.30 for models 1 through 4, respectively. The majority of center-level variation could not be explained through models containing both patient and intraoperative factors. CONCLUSIONS The results suggest that variation in center-level red blood cells transfusion cannot be explained by patient and procedural factors alone. Investigating organizational culture and programmatic infrastructure may be necessary to better understand variation in transfusion practices.
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Affiliation(s)
- David C Fitzgerald
- College of Health Professions, Medical University of South Carolina, Charleston, SC.
| | - Annie N Simpson
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Robert A Baker
- Cardiac Surgery Perfusion Services and Quality and Outcomes Unit, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Xiaoting Wu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Min Zhang
- Department of Biostatistics, University of Michigan, Ann Arbor, Mich
| | | | - Gaetano Paone
- Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich
| | - Alphonse Delucia
- Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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Kranenburg FJ, le Cessie S, Caram-Deelder C, van der Bom JG, Arbous MS. Determinants of transfusion decisions in the ICU: haemoglobin concentration, what else? - a retrospective cohort study. Vox Sang 2019; 114:816-825. [PMID: 31495950 DOI: 10.1111/vox.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to assess potentially relevant clinical characteristics which influence the decision to transfuse red cells in critically ill patients with low haemoglobin concentrations (6.0-10.0 g/dl). MATERIALS AND METHODS This was a retrospective observational cohort study of patients admitted between November 2004 and May 2016 at the intensive care unit (ICU) of the Leiden University Medical Center, Netherlands. Haemoglobin measurements, clinical variables and the subsequent transfusion decision were extracted from the electronic health records. Clinical variables were grouped by organ system. We first examined the association of each of the clinical variables with the decision to transfuse during the following 6 h after a haemoglobin measurement using generalized estimating equations. We then compared the predictive abilities of single variables within an organ system and the predictive ability of an organ system's combined variables using the change in Akaike information criterion (AIC). RESULTS A total of 83 394 haemoglobin measurements of 10 947 ICU admissions were included. Haemoglobin concentration was the most predictive for red cell transfusion. After the haemoglobin concentration, the combined variables for General Health, followed by the organ systems Cardiovascular and Pulmonary, were most predictive for red cell transfusion. Within these organ systems, the APACHE II score, referring department, APACHE admission diagnosis subgroup, troponin concentration, lactate concentration, respiratory rate, PaO2 /FiO2 and ventilation mode had the highest predictive ability. CONCLUSION Haemoglobin concentration is the dominant predictor for red cell transfusion. Other clinical characteristics are also predictive, though to a lesser extent.
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Affiliation(s)
- Floris J Kranenburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Sesmu Arbous
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Stammers AH, Tesdahl EA, Mongero LB, Stasko A. Gender and intraoperative blood transfusion: analysis of 54,122 non-reoperative coronary revascularization procedures. Perfusion 2018; 34:236-245. [DOI: 10.1177/0267659118808728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Previous studies have shown that women undergoing isolated coronary artery bypass graft (CABG) surgery have an increased risk for postoperative morbidity and mortality when compared to men. Additionally, recent evidence suggests that blood transfusions are independently associated with an increased risk of adverse outcome. Methods: We evaluated gender differences in the risk of intraoperative red blood cell (RBC) transfusion during CABG surgery. Consecutive, non-reoperative CABG procedures performed across 196 institutions between April 2012 and May 2015 were retrospectively reviewed. Gender differences for intraoperative transfusion were evaluated with a multi-variable binary logistic regression model, adjusting for age, blood volume (Nadler formula to normalize for height and weight), body mass index, procedure acuity, net extracorporeal circuit prime volume, use of autologous priming, first hematocrit (Hct) in the operating room (OR), nadir Hct on cardiopulmonary bypass (CPB), volume added on CPB, ultrafiltration volume, urine output on CPB and procedure duration. Results: Among 54,122 patients (25.3% female), 21.6% (n = 11,701) received a RBC transfusion. Compared to men, female patients were older (66 years vs. 64 years, p<0.001), had lower blood volumes (4.3L vs. 5.6L, p<0.001) and a lower preoperative Hct (32.9% vs. 37.2%, p<0.001). Transfusion rates were three-fold higher in women versus men (45.1% vs. 13.7%, p<0.001). After adjustment for independent predictors of intraoperative transfusion, women remained at increased risk versus men (OR = 1.30, 95%CI = 1.19−1.43). Conclusions: Women have an increased risk of intraoperative RBC transfusion versus men. After adjusting for height and weight, much of this risk is due to gender differences in preoperative Hct and blood volume; however, a residual significant risk remained after adjustment. Perfusion strategies aimed at gender differences may minimize unnecessary transfusions. Future study on the impact of gender on transfusion practice in cardiac surgery is warranted.
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Shehata N, Whitlock R, Fergusson DA, Thorpe KE, MacAdams C, Grocott HP, Rubens F, Fremes S, Lellouche F, Bagshaw S, Royse A, Rosseel PM, Hare G, Medicis ED, Hudson C, Belley-Cote E, Bainbridge D, Kent B, Shaw A, Byrne K, Syed S, Royse CF, McGuiness S, Hall J, Mazer CD. Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design of a Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2018; 32:121-129. [DOI: 10.1053/j.jvca.2017.10.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Indexed: 11/11/2022]
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10
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Makroo RN, Agrawal S, Chowdhry M. Rh and Kell Phenotype Matched Blood Versus Randomly Selected and Conventionally Cross Matched Blood on Incidence of Alloimmunization. Indian J Hematol Blood Transfus 2017; 33:264-270. [PMID: 28596662 DOI: 10.1007/s12288-016-0704-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022] Open
Abstract
There is paucity of literature regarding efficacy of transfusion of Rh and Kell matched blood in reducing alloimmunization risk among non-chronically transfused patients. A prospective study to compare efficacy of Rh and Kell phenotype matched blood over randomly selected and conventionally cross-matched blood on the incidence of alloimmunization in patients undergoing cardiac surgery was carried out in the Department of Transfusion Medicine at Indraprastha Apollo Hospitals, New Delhi, from 1st September, 2013 to 31st December, 2014. Two groups, A and B of 250 each were studied. Group A received ABO, Rh and Kell phenotype matched units. Group B received units matched only for ABO and Rh D. Retrospective analysis for antigenic exposures was done. Alloimmunization rate was evaluated for both groups after 72 h and 4 weeks and compared. A p value ≤0.05 was considered statistically significant. None of the patients in Group A were alloimmunized. In Group B, 119 patients received antigenic stimulus (single antigen stimuli- 93; multiple- 26). The probability of a patient being exposed was 52.4 %. At 6 weeks post transfusion, one patient developed 'Anti-E' and had received 'E' stimulus once. The rate of alloimmunization was 0.4 % in group B, 0.8 % overall and the risk of alloimmunization per unit transfused was 0.17 %. Non responders were 99.16 %. The study did not reach statistical significance (p = 0.238). Majority of our population are non-responders therefore, the resources and time can be reserved for providing Rh and Kell matched units for multiply transfused patients.
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Affiliation(s)
- Raj Nath Makroo
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study. LANCET HAEMATOLOGY 2016; 3:e139-48. [PMID: 26947202 DOI: 10.1016/s2352-3026(15)00283-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Perioperative haemorrhage negatively affects patient outcomes and results in substantial consumption of health-care resources. Plasma transfusions are often administered to address abnormal preoperative coagulation tests, with the hope to mitigate bleeding complications. We aimed to assess the associations between preoperative plasma transfusion and bleeding complications in patients with elevated international normalised ratio (INR) undergoing non-cardiac surgery. METHODS We did an observational study in a consecutive sample of adult patients undergoing non-cardiac surgery with preoperative INR greater than or equal to 1·5. The exposure of interest was transfusion of preoperative plasma for elevated INR. The primary outcome was WHO grade 3 bleeding in the early perioperative period (from entry into the operating room until 24 h following exit from operating room). Hypotheses were tested with univariate and propensity-matched analyses. We did multiple sensitivity analyses to further evaluate the robustness of study findings. FINDINGS Between Jan 1, 2008, and Dec 31, 2011, we identified 1234 (8·4%) of 14 743 patients who had an INR of 1·5 or above and were included in this investigation. Of 1234 study participants, 139 (11%) received a preoperative plasma transfusion. WHO grade 3 bleeding occurred in 73 (53%) of 139 patients who received preoperative plasma compared with 350 (32%) of 1095 patients who did not (odds ratio [OR] 2·35, 95% CI 1·65-3·36; p<0·0001). Among the propensity-matched cohort, 65 (52%) of 125 plasma recipients had WHO grade 3 bleeding compared with 97 (40%) of 242 of those who did not receive preoperative plasma (OR 1·75, 95% CI 1·09-2·81; p=0·021). Results from multiple sensitivity analyses were qualitatively similar. INTERPRETATION Preoperative plasma transfusion for elevated international normalised ratios was associated with an increased frequency of perioperative bleeding complications. Findings were robust in the sensitivity analyses, suggestive that more conservative management of abnormal preoperative international normalised ratios is warranted. FUNDING Mayo Clinic, National Institutes of Health.
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Yaffee DW, DeAnda A, Ngai JY, Ursomanno PA, Rabinovich AE, Ward AF, Galloway AC, Grossi EA. Blood Conservation Strategies Can Be Applied Safely to High-Risk Complex Aortic Surgery. J Cardiothorac Vasc Anesth 2015; 29:703-9. [DOI: 10.1053/j.jvca.2014.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 11/11/2022]
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Greiff G, Pleym H, Stenseth R, Berg KS, Wahba A, Videm V. Prediction of Bleeding After Cardiac Surgery: Comparison of Model Performances: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2015; 29:311-9. [DOI: 10.1053/j.jvca.2014.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Indexed: 11/11/2022]
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Prick BW, Schuit E, Mignini L, Jansen AJG, van Rhenen DJ, Steegers EAP, Mol BW, Duvekot JJ. Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage. BJOG 2015; 122:1789-97. [DOI: 10.1111/1471-0528.13224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- BW Prick
- Department of Gynaecology and Obstetrics; Maasstad Hospital; Rotterdam the Netherlands
- Department of Obstetrics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Stanford Prevention Research Center; Stanford University; Stanford CA USA
| | - L Mignini
- Centro Rosarino de Estudios Perinatales (CREP); Rosario Argentina
| | - AJG Jansen
- Sanquin Blood Supply Foundation; Rotterdam the Netherlands
| | - DJ van Rhenen
- Sanquin Blood Supply Foundation; Rotterdam the Netherlands
| | - EAP Steegers
- Department of Obstetrics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - BW Mol
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - JJ Duvekot
- Department of Obstetrics; Erasmus Medical Centre; Rotterdam the Netherlands
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Jy W, Gómez-Marín O, Salerno TA, Panos AL, Williams D, Horstman LL, Ahn YS. Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2015; 149:305-11. [DOI: 10.1016/j.jtcvs.2014.10.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/29/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
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Neill S, Engoren M, Kouatli Y, Shields TA, Jewell E, Pagani FD. Risk factors related to transfusion requirements in patients undergoing implantation of ventricular assist devices. J Cardiothorac Vasc Anesth 2014; 29:297-302. [PMID: 25488077 DOI: 10.1053/j.jvca.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The identification of transfusion risk factors in patients receiving left ventricular assist devices to allow for targeted use of blood conservation strategies and improved blood utilization. DESIGN This is a retrospective analysis of prospectively collected data between April 2009 and June 2012. Linear regression was used to determine factors associated with increased transfusion. Logistic regression was used to determine factors that were associated with more than the median number of units transfused. SETTING Single center, university hospital. PARTICIPANTS Patients (n=144) who underwent left ventricular assist device implantation. INTERVENTION Transfused blood product data for the day of surgery and for 3 days after were obtained from the blood bank. MEASUREMENTS AND MAIN RESULTS Beta-blockers were associated with 1.7±0.65 fewer red blood cell (RBC) units and 2.2±0.7 fewer fresh frozen plasma units transfused. Each year of older age was associated with 0.113±0.023 units of RBC, 0.543±0.101 platelet, and 0.098±0.017 plasma units transfused. International normalized ratio was associated with more platelet transfusion (20.813±5.757 units per 1.0 increase), but not with plasma or RBC transfusion. Lower platelet counts were associated with both platelet (-0.045±0.019 units per 10,000 μL(-1)) and plasma transfusions (-0.011±0.004). Myocardial infarction was associated with increased RBC and plasma transfusion, and cardiogenic shock was associated with increased platelet transfusions, but nitrate use was associated with reduced platelet transfusion. CONCLUSION Beta-blockers may be a modifiable factor to decrease transfusions. The association between international normalized ratio and platelet transfusions suggests that better determination of the type of coagulopathy may promote more appropriate transfusions.
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Nolan HR, Davenport DL, Ramaiah C. BMI Is an Independent Preoperative Predictor of Intraoperative Transfusion and Postoperative Chest-Tube Output. Int J Angiol 2014; 22:31-6. [PMID: 24436581 DOI: 10.1055/s-0033-1333865] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background An increasing obese population in the United States focuses attention on perioperative management of obese and overweight patients. Objective We sought to determine if obesity, determined by body mass index (BMI), was a preoperative indicator of bleeding in coronary artery bypass graft (CABG) surgery as measured by intraoperative packed red blood cell transfusion frequency and 24-hour chest-tube output amount. Methods A retrospective chart review examined 290 consecutive patients undergoing single-surgeon off-pump or on-pump CABG surgery between November 2003 and April 2009. Preoperative variables of age, gender, hematocrit, platelet count, and BMI, chest tube output during the immediate 24-hour postoperative period, and the type of procedure (on-pump vs. off-pump) were analyzed. Logistic regression analysis was used to evaluate the likelihood of intraoperative transfusion. Linear regression analysis was used to evaluate 24-hour chest-tube output. Results Preoperative variables that significantly increased the likelihood of intraoperative transfusions were older age and low hematocrit; a significant decrease in likelihood was found with male gender, overweight BMI, and off-pump procedures. Preoperative variables that significantly increased 24-hour chest-tube output were low hematocrit, high hematocrit, and low platelets while a significant decrease in output was seen with overweight BMI and obese BMI. Conclusion Overweight and obese BMI are significant independent predictors of decreased intraoperative transfusion and decreased postoperative blood loss.
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Affiliation(s)
- Heather R Nolan
- Department of Surgery, Mercer University School of Medicine, Macon, Georgia
| | - Daniel L Davenport
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Chandrashekhar Ramaiah
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Brauer SD, Applegate RL, Jameson JJ, Hay KL, Lauer RE, Herrmann PC, Bull BS. Association of Plasma Dilution With Cardiopulmonary Bypass-Associated Bleeding and Morbidity. J Cardiothorac Vasc Anesth 2013; 27:845-52. [DOI: 10.1053/j.jvca.2013.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Indexed: 11/11/2022]
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Sá MPBDO, Soares EF, Santos CA, Figueiredo OJ, Lima ROA, Rueda FGD, Escobar RRD, Soares AMMN, Lima RDC. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery. Braz J Cardiovasc Surg 2012; 26:552-8. [PMID: 22358269 DOI: 10.5935/1678-9741.20110044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/16/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. The aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after CABG in our local cardiac surgical service. METHODS 435 patients undergoing isolated first-time CABG were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. Patients were 255 males and 180 females, with mean age 62.01 ± 10.13 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. RESULTS Blood transfusion was used in 263 patients (60.5%). The mean number of transfused blood products units per patient was 2.27 ± 3.07 (0-23) units. The total number of transfused units of blood products was 983. Univariate analysis identified age >65 years, weight <70 Kg, body mass index <25 Kg/m2, hemoglobin <13mg/dL, hematocrit < 40% and ejection fraction <50%, use of cardiopulmonary bypass (CPB), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. The strongest predictors using multivariate analysis were hematocrit < 40% (OR 2.58; CI 1.62-4.15; P<0.001), CPB use (OR 2.00; CI 1.27-3.17; P=0.003) and multiple bypasses (OR 2.31; CI 1.31-4.08; P=0.036). CONCLUSIONS The identification of these risk factors leads to better identification of patients with a greater probability of using blood, allocation blood bank resources and cost-effectiveness use of blood products.
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De Santo LS, Amarelli C, Della Corte A, Scardone M, Bancone C, Carozza A, Grassia MG, Romano G. Blood transfusion after on-pump coronary artery bypass grafting: focus on modifiable risk factors. Eur J Cardiothorac Surg 2012; 43:359-66. [DOI: 10.1093/ejcts/ezs223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nalla BP, Freedman J, Hare GMT, Mazer CD. Update on blood conservation for cardiac surgery. J Cardiothorac Vasc Anesth 2011; 26:117-33. [PMID: 22000983 DOI: 10.1053/j.jvca.2011.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Bhanu P Nalla
- Department of Anesthesia, Keenan Research Center in the Li Ka Shing Knowledge Translation Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Simeone F, Franchi F, Cevenini G, Marullo A, Fossombroni V, Scolletta S, Biagioli B, Giomarelli P, Barbini P. A simple clinical model for planning transfusion quantities in heart surgery. BMC Med Inform Decis Mak 2011; 11:44. [PMID: 21693020 PMCID: PMC3141374 DOI: 10.1186/1472-6947-11-44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 06/21/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery continue to be the largest demand on blood transfusions. The need for transfusion is based on the risk of complications due to poor cell oxygenation, however large transfusions are associated with increased morbidity and risk of mortality in heart surgery patients. The aim of this study was to identify preoperative and intraoperative risk factors for transfusion and create a reliable model for planning transfusion quantities in heart surgery procedures. METHODS We performed an observational study on 3315 consecutive patients who underwent cardiac surgery between January 2000 and December 2007. To estimate the number of packs of red blood cells (PRBC) transfused during heart surgery, we developed a multivariate regression model with discrete coefficients by selecting dummy variables as regressors in a stepwise manner. Model performance was assessed statistically by splitting cases into training and testing sets of the same size, and clinically by investigating the clinical course details of about one quarter of the patients in whom the difference between model estimates and actual number of PRBC transfused was higher than the root mean squared error. RESULTS Ten preoperative and intraoperative dichotomous variables were entered in the model. Approximating the regression coefficients to the nearest half unit, each dummy regressor equal to one gave a number of half PRBC. The model assigned 4 units for kidney failure requiring preoperative dialysis, 2.5 units for cardiogenic shock, 2 units for minimum hematocrit at cardiopulmonary bypass less than or equal to 20%, 1.5 units for emergency operation, 1 unit for preoperative hematocrit less than or equal to 40%, cardiopulmonary bypass time greater than 130 minutes and type of surgery different from isolated artery bypass grafting, and 0.5 units for urgent operation, age over 70 years and systemic arterial hypertension. CONCLUSIONS The regression model proved reliable for quantitative planning of number of PRBC in patients undergoing heart surgery. Besides enabling more rational resource allocation of costly blood-conservation strategies and blood bank resources, the results indicated a strong association between some essential postoperative variables and differences between the model estimate and the actual number of packs transfused.
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Affiliation(s)
- Felicetta Simeone
- Unit of Cardiothoracic Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Federico Franchi
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
| | - Gabriele Cevenini
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
| | - Antonino Marullo
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
| | - Vittorio Fossombroni
- Unit of Immune Haematology and Transfusion Medicine, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sabino Scolletta
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
| | - Bonizella Biagioli
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
| | | | - Paolo Barbini
- Department of Surgery and Bioengineering, Università di Siena, Siena, Italy
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Barr PJ, Donnelly M, Cardwell C, Alam SS, Morris K, Parker M, Bailie KEM. Drivers of transfusion decision making and quality of the evidence in orthopedic surgery: a systematic review of the literature. Transfus Med Rev 2011; 25:304-16.e1-6. [PMID: 21640550 DOI: 10.1016/j.tmrv.2011.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reasons for variation in transfusion practice in orthopedic surgery are not well understood. This systematic review identified and appraised the quality of the literature in this area to assess the impact of factors associated with the use of allogeneic red blood cell (RBC) transfusion in orthopedic procedures. MEDLINE and EMBASE databases were searched for relevant English language publications. Articles containing a range of MeSH and text terms regarding "blood transfusion," "predictors," and "multiple logistic regression" were retrieved. Articles that focused on patients undergoing orthopedic procedures and that met prespecified inclusion criteria were appraised in terms of potential bias and the appropriateness of statistical approach. A total of 3641 citations were retrieved, and 29 met the inclusion criteria for the review. Articles reported on a range of orthopedic procedures including total hip arthroplasty; total knee arthroplasty, total shoulder arthroplasty, and spinal surgery. Most studies were conducted in the United States (n = 12) or Canada (n = 5). Study quality was moderate; 50% or more of the quality criteria were assessed in 15 articles. Particular areas of concern were the lack of prospective studies, lack of clarity in defining the time interval between risk factor assessment and transfusion outcome, and lack of model validation. A narrative synthesis found that 2 factors consistently influenced the use of RBC transfusion-decreased hemoglobin (n = 25) and increased patient age (n = 18). Increased surgical complexity (n = 12), low body weight (n = 9), presence of additional comorbidities (n = 9), and female sex (n = 7) were also important factors. The general quality of the studies in the field is weak. However, low hemoglobin and increasing age were consistently identified as independent risk factors for RBC transfusion in orthopedic practice. Additional or alternative analytical approaches are required to obtain a more comprehensive, holistic understanding of the decision to transfuse RBCs to patients undergoing orthopedic surgery.
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Affiliation(s)
- Paul James Barr
- Centre for Excellence in Public Health, Queen's University Belfast, Northern Ireland, UK.
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Is chronic obstructive pulmonary disease an independent risk factor for transfusion in coronary artery bypass graft surgery? Eur J Cardiothorac Surg 2011; 40:1285-90. [DOI: 10.1016/j.ejcts.2011.02.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/23/2011] [Accepted: 02/25/2011] [Indexed: 11/30/2022] Open
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Afshari A, Wikkelsø A, Brok J, Møller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev 2011:CD007871. [PMID: 21412912 DOI: 10.1002/14651858.cd007871.pub2] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe bleeding and coagulopathy as a result of massive transfusion are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy but their roles remain disputed. OBJECTIVES To systematically assess the benefits and harms of a TEG or ROTEM guided transfusion strategy in randomized trials involving patients with severe bleeding. SEARCH STRATEGY Randomized clinical trials (RCTs) were identified from electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 9); MEDLINE; EMBASE; Science Citation Index Expanded; International Web of Science; CINAHL; LILACS; and the Chinese Biomedical Literature Database (up to 31st October 2010). We contacted trial authors, authors of previous reviews, and manufacturers in the field. SELECTION CRITERIA We included all RCTs, irrespective of blinding or language, that compared transfusion guided by TEG or ROTEM to transfusion guided by clinical judgement and standard laboratory tests, or both. DATA COLLECTION AND ANALYSIS Two authors independently abstracted data; they resolved any disagreements by discussion. We presented pooled estimates of the intervention effects on dichotomous outcomes as relative risks (RR) and on continuous outcomes as mean differences, with 95% confidence intervals (CI). Our primary outcome measure was all cause mortality. We performed subgroup and sensitivity analyses to assess the effect of TEG or ROTEM in adults and children on various clinical and physiological outcomes. We assessed the risk of bias through assessment of trial methodological components and the risk of random error through trial sequential analysis. MAIN RESULTS We included nine RCTs with a total of 776 participants; only one trial had a low risk of bias. We found two ongoing trials but were unable to retrieve any data from them. Compared with standard treatment, TEG or ROTEM showed no statistically significant effect on overall mortality (3.78% versus 5.11%, RR 0.77, 95% CI 0.35 to 1.72; I(2) = 0%) but only five trials provided data on mortality. Our analyses demonstrated a statistically significant effect of TEG or ROTEM on the amount of bleeding (MD -85.05 ml, 95% CI -140.68 to -29.42; I(2) = 26%) but failed to show any statistically significant effect on other predefined outcomes. AUTHORS' CONCLUSIONS There is an absence of evidence that TEG or ROTEM improves morbidity or mortality in patients with severe bleeding. Application of a TEG or ROTEM guided transfusion strategy seems to reduce the amount of bleeding but whether this has implications for the clinical condition of patients is still uncertain. More research is needed.
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Affiliation(s)
- Arash Afshari
- The Cochrane Anaesthesia Review Group & Copenhagen Trial Unit and Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, Blegdamsvej 9, Afsnit 3342, rum 52, Copenhagen, Denmark, 2100
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Welsby I, Crow J, Bandarenko N, Lappas G, Phillips-Bute B, Stafford-Smith M. A clinical prediction tool to estimate the number of units of red blood cells needed in primary elective coronary artery bypass surgery. Transfusion 2010; 50:2337-43. [DOI: 10.1111/j.1537-2995.2010.02711.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Pommerol M, Gilleron V, Kostrzewa A, Roger I, Boiron JM, Salmi LR. [Characteristics of transfusion recipients in Bordeaux University Hospital. A descriptive study using hospital claims and haemovigilance system databases]. Transfus Clin Biol 2010; 17:223-31. [PMID: 20965767 DOI: 10.1016/j.tracli.2010.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/16/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The steady increase of the blood demand since 2001 requires to study the clinical characteristics of blood components recipients. The objective was to describe patients transfused in 2006 in Bordeaux University Hospital, and to identify the diseases which justified the transfusion practice, using French hospital claims database. STUDY DESIGN Data from haemovigilance system were linked to hospital claims databases in order to describe patients transfused in 2006. To target diseases related to transfusion, a list of diagnoses considered as markers for transfusion was drawn up, and validated by physicians prescribing blood components. RESULTS Among the 100,004 patients admitted to hospital in 2006, 6275 (6.3%) received blood components; 46,727 blood units were transfused to these patients, including 67% of red blood cell, 13% of platelet concentrates and 20% of fresh-frozen plasma; 69% of blood units were prescribed in medical wards, 30% in surgery wards and 1% in gynaecology and obstetrics. The main diagnoses associated with blood transfusion were circulatory complications after cardiac surgery (80% of patients with this diagnosis were transfused), bone marrow aplasia (76% of patients), anaemia (55%), and gastro-intestinal bleeding (48%). The highest numbers of blood units were transfused to patients with hypovolemic, traumatic or postoperative shock, anaemia, hemopathy, or coagulation disorders. CONCLUSION This study provided a clinical profile of the transfused patients. Data collected could be used to plan blood collection and to define objectives and resources of healthcare establishments.
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Affiliation(s)
- M de Pommerol
- Service d'information médicale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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INGHILLERI GIOVANNI. Prediction of transfusion requirements in surgical patients: a review. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1778-428x.2009.01118.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Millán C, Quintana B, Rodríguez A, Iglesias M, Barranco M, Navia J. [Efficacy of recombinant activated factor VII for massive bleeding after cardiac surgery: experience with 32 patients]. ACTA ACUST UNITED AC 2010; 56:485-92. [PMID: 19994617 DOI: 10.1016/s0034-9356(09)70439-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the efficacy of recombinant activated factor VII (rFVIIa) to treat massive bleeding refractory to conventional treatment following cardiac surgery. PATIENTS AND METHODS Retrospective study of 32 adults who underwent cardiac surgery and received rFVIIa to treat life-threatening postoperative bleeding after conventional means of correcting coagulopathy had failed. RESULTS After administration of rFVIIa (90 microg x kg(-1), coagulation parameters soon became normal and blood loss decreased, with drainage going from a mean (SD) of 463 (321) mL in the hour when rFVIIa was infused to 155 (101) mL in the next hour (P < .001). Blood loss decreased by between 22% and 90% (mean, 66%), and the reduction was over 75% in 45% of the patients. Decreases in the transfusion of packed red blood cells (from 7A.4 [4.1] units to 2.7 [ 2.9] units; P < .001), plasma (from 4.7 [2.9] units to 1.6 [2.0] units; P < .001), and platelets were also noted. Mortality was 25%, although only 1 patient died from hemorrhagic shock. One patient developed thromboembolic complications (ischemic stroke). CONCLUSION rFVIIa was effective in treating refractory bleeding after cardiac surgery, reducing blood loss and transfusion requirements and restoring blood parameters to normal.
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Affiliation(s)
- C Millán
- Departamento de Anestesiología y Reanimación, Hospital General Universitario "Gregorio Marañńon", Madrid.
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Bibliography. Current world literature. Diseases of the aorta, pulmonary, and peripheral vessels. Curr Opin Cardiol 2008; 23:646-7. [PMID: 18830082 DOI: 10.1097/hco.0b013e328316c259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shehata N, Wilson K, Mazer CD, Tomlinson G, Streiner D, Hébert P, Naglie G. The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital. Can J Anaesth 2007; 54:902-7. [DOI: 10.1007/bf03026794] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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