Current State of Patient Blood Management in Cardiovascular Surgery: Insights from a Survey of Leading Centers
Abstract
Objective
To determine the state of patient blood management (PBM) practice in leading US cardiac surgery centers.
Design
A survey tool addressing PBM program structure and PBM program operations was deployed. The survey also incorporated practice in managing certain case scenarios.
Setting
Cardiac surgery centers.
Intervention
None.
Participants
The US News and World Reports 2024 top 25 cardiac surgery centers.
Measurements and Main Results
Only 29% of sites had full-time equivalents committed to PBM. The approach to informed consent varied among sites. Most sites (54%) obtained informed consent to cover the entire hospital stay. Consent for non-emergent transfusion was obtained at 21% of sites. Preadmission anemia screening was deployed for longer than 2 weeks in 29% of sites. While many anesthesia techniques associated with blood conservation were used by the majority (e.g., acute normovolemic hemodilution 92%, retrograde autologous priming 95%), simple steps like adjusting cardiopulmonary (CPB) circuits for patient size were only offered at 43% of sites.
Conclusions
Key features of well-designed PBM programs were not found in many of the surveyed programs. This audit suggests an opportunity for PBM growth across cardiovascular surgery programs.