Con: Routine Use of Fresh Frozen Plasma Should Not Be Used to Prime Cardiopulmonary Bypass Circuits During Cardiac Surgery
In this review, the authors examine the use of fresh frozen plasma (FFP) for priming the cardiopulmonary bypass (CPB) circuit and discuss the lack of evidence supporting its routine use in this population.
Comparison of Clinical Scoring Tools to Predict Heparin-Induced Thrombocytopenia in Cardiac Surgery
The CPB score is the preferred HIT clinical scoring tool in adult cardiac surgery patients, whereas the 4Ts score performed less effectively. A cut-off of ≥ 3 points on the CPB score could increase specificity while preserving high sensitivity, which should be validated in a prospective evaluation.
Evaluation of the Impact of HMS Plus on Postoperative Blood Loss Compared with ACT Plus in Cardiac Surgery
HMS Plus did not reduce the mean blood-loss volume during the first 24 postoperative hours compared with ACT Plus. Its utility for potential transfusion rate reduction remains to be proven.
Novel Autologous, High Concentrated Fibrin as Advanced Hemostatic Agent for Coronary Surgery
Autologous bio-regenerative fibrin can be safely prepared, with no time consuming, and was demonstrated to be a useful tool to decrease allogeneic blood transfusion requirements following elective coronary artery bypass grafting surgery. A prospective randomized trial is needed to confirm these findings.
Optimal Protamine Dosing after Cardiopulmonary Bypass: The PRODOSE Adaptive Randomised Controlled Trial
Using a mathematical model to guide protamine dosing in patients following CPB improved TEG r-time and reduced the dose administered relative to a fixed ratio. No differences were detected in postoperative mediastinal/pleural drainage or red blood cell transfusion requirement in our cohort of low-risk patients.
Variability of Three Activated Clotting Time Point-Of-Care Systems in Cardiac Surgery: Reinforcing Available Evidence
The differences found in comparisons are considered to be clinically relevant, which is why it is considered important to make the variability of the different monitoring systems known and to take them into account for optimal control of this parameter and its clinical repercussions.
STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management
Our intent is to present the most comprehensive set of guidelines possible, and we hope that this will serve as a resource so as to improve the outcomes of patients undergoing cardiothoracic surgery.
Towards Manufactured Red Blood Cells for the Treatment of Inherited Anemia
This review discusses recent progress in the erythroid culture field as well as opportunities for further scaling up of manufactured RBC production for transfusion practice.
Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States
Compared with the 2013 pediatric population, extracorporeal membrane oxygenation center anticoagulation and blood transfusion approaches continue to vary widely. Most report continued use of heparin as their primary anticoagulant and follow a combination of monitoring assays with the majority using the antifactor Xa assay in their practices, a significant shift from prior results. Antithrombin activity levels and viscoelastic tests are followed by a growing number of centers. Platelet transfusion thresholds continue to vary widely. Future research is needed to establish optimal anticoagulation and blood transfusion management.
Retrograde Autologous Priming During Cardiopulmonary Bypass Reduces Blood Transfusion Rate in Adult Cardiac Surgery: A Prospective Randomized Clinical Trial
In this experiment, the lowest HCT value during CPB in the study group was significantly higher and only 20% of patients received a blood transfusion. The overall transfusion rate and intraoperative transfusion volume of homologous PRBC units in the RAP group were lower than those in the standard priming group.
Cell Salvage in Trauma
Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.
Controversies in the Clinical Practice of Patient Blood Management
This special article focuses on the current evidence and controversies in the clinical practice of PBM and on emerging data related to specific PBM-related interventions in patients undergoing cardiac surgery. Strong evidence for many PBM-related interventions is limited because of missing studies or the poor quality of published findings and study endpoints.