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Preventing and managing catastrophic bleeding during extracorporeal circulation

Abstract The use of extracorporeal circulation for cardiac surgery and extracorporeal life support poses tremendous challenges to the hemostatic equilibrium given its diametric tendency to trigger hyper‐ and hypocoagulopathy. The..

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Lactate clearance in infants undergoing surgery for congenital heart disease

Abstract Measurement of lactate concentrations during cardiac surgery with cardiopulmonary bypass (CPB) is a reliable monitoring tool for the assessment of the adequacy of perfusion, and a predictor of poor..

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The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass

Abstract Background: Ultrafiltration during cardiopulmonary bypass (CPB) reduces fluid overload and inflammatory mediators in open-heart surgery and is thought to reduce the risk of red blood cell (RBC) transfusion. We..

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Clinical impact of disinvestment in hydroxyethyl starch for patients undergoing coronary artery bypass surgery: a retrospective observational study

Abstract Purpose To examine the effect of discontinuing hydroxyethyl starch (HES) solutions on length of hospital stay, transfusion, risk of death, acute kidney injury (AKI), and dialysis. Methods We conducted..

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Zero‐Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and Improves the Respiratory Function in Infants After Cardiopulmonary Bypass: A Randomized Controlled…

Abstract Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and infants to avoid exceeding hemodilution; however, transfusion‐related inflammation affects post‐CPB outcomes in infant open‐heart surgery. Procalcitonin, a newly..

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Hematocrit and impact of transfusion in patients receiving extracorporeal life support

Abstract Introduction:  Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this..

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Short-term outcome of cardiac surgery under cardiopulmonary bypass in patients who refuse transfusion: a controlled study

Abstract BACKGROUND: Although bloodless cardiac surgery has been successfully performed for many years, studies with controls permitting transfusion are few and their results inconclusive. This study compares the outcome of..

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Patient Blood Management in Pediatric Cardiac Surgery: A Review

Abstract Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant..

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Calculation Algorithm Reduces Protamine Doses Without Increasing Blood Loss or the Transfusion Rate in Cardiac Surgery: Results of a Randomized…

Abstract Objectives The aim of the study was to investigate whether the HeProCalc algorithm affects heparin and  dosage, , and transfusion rate. Design Randomized controlled trial. Setting University hospital. Participants The..

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National Benchmarks for Proportions of Patients Receiving Blood Transfusions During Pediatric and Congenital Heart Surgery: An Analysis of the STS…

Abstract Background To determine national benchmarks and assess variability across centers, The Society of Thoracic Surgeons Congenital Heart Surgery Database was analyzed to document proportions of patients receiving intraoperative transfusion..

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Increased blood transfusion and its impact in patients having tracheostomy while on extracorporeal membrane oxygenation

Abstract Introduction: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be..

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Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?

Abstract Background Over the past decade, minimally invasive mitral valve surgery (MIMVS) has grown in popularity. Less invasive approaches to mitral valve surgery are increasingly used for improved cosmesis. We..

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Feasibility of autologous intraoperative blood collection and retransfusion in small children with complex congenital heart defects undergoing cardiopulmonary bypass

Abstract Introduction Allogeneic blood product transfusion is common in pediatric patients undergoing cardiopulmonary bypass although it is associated with an increased risk for adverse events. Furthermore, numerous donor exposures may..

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Bleeding, Thrombosis, and Transfusion With Two Heparin Anticoagulation Protocols in Venoarterial ECMO Patients

Abstract Objective To compare the incidence of bleeding and  between adult venoarterial (VA)  (ECMO) patients managed with an  (ACT)-guided heparin  protocol and activated  (aPTT) protocol. Design . Setting Tertiary care, academic medical center...

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Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery

Abstract Acute kidney injury (AKI) is a common and serious complication of cardiac surgical procedures that require prolonged (>90 min) cardiopulmonary bypass (CPB) (, ). Although the presence of AKI after..

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Preoperative anemia versus blood transfusion: Which is the culprit for worse outcomes in cardiac surgery?

Abstract Background Reducing blood product utilization after cardiac surgery has become a focus of  as studies have suggested improved outcomes. The relative impact of preoperative anemia versus packed red blood cells..

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A red cell preservation strategy reduces postoperative transfusions in pediatric heart surgery patients

Summary Background Blood transfusion has well‐documented adverse effects. As part of a blood conservation initiative at our center, we began routine use of cell saver for all congenital heart surgery..

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Hetastarch Should be Avoided for Volume Expansion in Cardiac Surgery Patients

Abstract Blood conservation measures to reduce perioperative blood loss during cardiac surgery have been a subject of focus in recent years. This is due in part to the high cost..

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Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis

Abstract Background:  Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP..

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Retrograde autologous priming in surgery of thoracic aortic aneurysm

Abstract OBJECTIVES Surgery of thoracic aortic aneurysm (TAA) is associated with blood loss and coagulopathy and a high need for red blood cell (RBC) volume. Retrograde autologous priming (RAP) decreases..

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Identification of mesothelial cells in intraoperative blood salvage

Abstract Intraoperative auto-transfusion with the use of cell saver systems is routinely used to reduce the rate of packed red blood transfusion in major surgery. Nevertheless some concerns have been..

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Inflammation and coagulation following minimally invasive extracorporeal circulation technologies

Abstract Minimally invasive extracorporeal perfusion technologies are based on the use of a minimally invasive extracorporeal circulation (MiECC) system. This includes a closed CPB circuit; biologically inert blood contact surfaces;..

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Case report: Intraoperative thrombosis cardiac arrest in extended right hepatectomy involving use of local haemostatic agent in intraoperative cell salvage…

Abstract Introduction In modern surgical era, local haemostatic agents and blood components such as recombinant activated factor VII (rFVIIa) have expanded surgeons’ armamentarium in controlling “surgical” and “nonsurgical bleeding”. We..

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Shifts of Transfusion Demand in Cardiac Surgery After Implementation of Rotational Thromboelastometry–Guided Transfusion Protocols: Analysis of the HEROES-CS (HEmostasis Registry…

Abstract Objectives Rotational  (ROTEM)-guided transfusion algorithms in cardiac surgery have been proven to be successful in reducing blood loss in randomized controlled trials. Using an institutional  registry of patients in cardiac surgery..

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Effects of Implementing Rotational Thromboelastometry in Cardiac Surgery: A Retrospective Cohort Study

Abstract Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac..

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Hematologic Evaluation of Intraoperative Autologous Blood Collection and Allogeneic Transfusion in Cardiac Surgery

Abstract Background Acute normovolemic hemodilution is recommended as a technique to reduce allogeneic red blood cell (RBC) transfusions in cardiac surgery, but its efficacy to reduce non‐RBC transfusion has not..

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Audit of transfusion of blood products in paediatric congenital heart surgery on cardiopulmonary bypass

Abstract Background: Cardiac surgery is associated with peri-operative bleeding, which may result in the need for blood transfusion, particularly in paediatric congenital cardiac surgery on cardiopulmonary bypass (CPB). There is..

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Fish Oil and Perioperative Bleeding

Abstract Background Fish oil is among the most common natural supplements for treatment of hypertriglyceridemia or prevention of cardiovascular disease. However, concerns about theoretical bleeding risk have led to recommendations..

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Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial

Abstract Background Adult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may..

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Association of Anaesthetists guidelines: cell salvage for peri‐operative blood conservation 2018

Abstract The use of cell salvage is recommended when it can be expected to reduce the likelihood of allogeneic (donor) red cell transfusion and/or severe postoperative anaemia. We support and..

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