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Evaluation of a novel Cardiac Peri-Operative Transfusion Trigger Scoring system in patients with coronary artery disease
Ma HP, Zhang L, Chen CL, Li J, Ma ZT, Jiang QQ, Liang YY, Li SS, Long F, Zheng H
BMC cardiovascular disorders. 2021;21(1):40
Abstract
BACKGROUND A simple and accurate scoring system to guide perioperative blood transfusion in patients with coronary artery disease (CAD) undergoing cardiac surgery is lacking. The trigger point for blood transfusions for these patients may be different from existing transfusion guidelines. This study aimed to evaluate the safety and efficacy of a new scoring strategy for use in guiding transfusion decisions in patients with CAD. METHODS A multicenter randomized controlled trial was conducted at three third-level grade-A hospitals from January 2015 to May 2018. Data of 254 patients in a Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) group and 246 patients in a group receiving conventional evaluation of the need for transfusion (conventional group) were analysed. The requirements for transfusion and the per capita consumption of red blood cells (RBCs) were compared between groups. RESULTS Baseline characteristics of the two groups were comparable. Logistic regression analyses revealed no significant differences between the two groups in primary outcomes (1-year mortality and perioperative ischemic cardiac events), secondary outcomes (shock, infections, and renal impairment), ICU admission, and ICU stay duration. However, patients in the cPOTTS group had significantly shorter hospital stays, lower hospital costs, lower utilization rate and lower per capita consumption of transfused RBCs than controls. Stratified analyses revealed no significant differences between groups in associations between baseline characteristics and perioperative ischemic cardiac events, except for hemofiltration or dialysis and NYHA class in I. CONCLUSIONS This novel scoring system offered a practical and straightforward guideline of perioperative blood transfusion in patients with CAD. Trial registration chiCTR1800016561(2017/7/19).
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Low-dose sevoflurane may reduce blood loss and need for blood products after cardiac surgery: a prospective, randomized pilot study
Tan Z, Zhou L, Qin Z, Luo M, Chen H, Xiong J, Li J, Liu T, Du L, Zhou J
Medicine. 2016;95((17)):e3424.
Abstract
Patients undergoing cardiac surgery often experience abnormal bleeding, due primarily to cardiopulmonary bypass (CPB)-induced activation of platelets. Sevoflurane may inhibit platelet activation, raising the possibility that administering it during CPB may reduce blood loss.Patients between 18 and 65 years old who were scheduled for cardiac surgery under CPB at our hospital were prospectively enrolled and randomized to receive intravenous anesthetics alone (control group, n = 77) or together with sevoflurane (0.5-1.0 vol/%) from an oxygenator (sevoflurane group, n = 76). The primary outcome was postoperative blood loss, the secondary outcome was postoperative need for blood products.Volume of blood loss was 48% lower in the sevoflurane group than the control group at 4 hours after surgery, and 33% lower at 12 hours after surgery. Significantly fewer patients in the sevoflurane group lost >700 mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result, the sevoflurane group received significantly smaller volumes of packed red blood cells (1.25 +/- 2.36 vs 2.23 +/- 3.75 units, P = 0.011) and fresh frozen plasma (97 +/- 237 vs 236 +/- 344 mL, P = 0.004). Thus the sevoflurane group was at significantly lower risk of requiring complex blood products after surgery (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17-0.68, P = 0.002).Sevoflurane inhalation from an oxygenator during CPB may reduce blood loss and need for blood products after cardiac surgery.
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Effect of different albumin concentrations in extracorporeal circuit prime on perioperative fluid status in young children
Yu K, Liu Y, Hei F, Li J, Long C
ASAIO Journal. 2008;54((5):):463-6.
Abstract
This study examined the effects of different dosages of albumin priming for extracorporeal circuit (ECC) on perioperative fluid status and fluid management in young children. A total of 151 consecutive pediatric patients (2-36 months old) scheduled for open heart surgery, were divided into two groups randomly, to receive either a 3% albumin solution (L group, n = 68) or a 5% albumin (H group, n = 83). Perioperative fluid intake, urine output, blood loss, diuretic dosage, the use of allogeneic blood products, ultrafiltration, and daily balance were recorded for 24 hrs in intensive care unit (ICU). Serial hematocrits, colloid osmotic pressure (COP) were measured. Outcomes and complications were documented. There were no significant differences in demographics, types of surgical procedures, baseline data such as hemoglobin, COP, and serum albumin. Patients in H group had significantly higher COPs, less urine output and more diuretic usage during operation and postoperatively (p < 0. 05); at 6 hrs postoperatively, there were no differences between two groups. No statistically significant differences were found between the two groups in blood loss and the amount of allogenic blood products infused, length of mechanical ventilation, ICU or hospital stay, complications, or mortality. Higher concentration of albumin prime in ECC showed decreased positive fluid balances, but produced less urine output and required more diuretic usage postoperatively. Thus, no significant clinical benefit resulted from the increased dosage.
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The reduction of the allogenic transfusion requirement in aortic surgery with a hemoglobin-based solution
LaMuraglia GM, O'Hara PJ, Baker WH, Naslund TC, Norris EJ, Li J, Vandermeersch E
Journal of Vascular Surgery. 2000;31((2):):299-308.
Abstract
OBJECTIVE Because of allogenic red blood cell (RBC) availability and infection problems, novel alternatives, including hemoglobin-based oxygen-carrying solutions (HBOC), are being explored to minimize the perioperative requirement of RBC transfusions. This study evaluated HBOC-201, a room-temperature stable, polymerized, bovine-HBOC, as a substitute for allogenic RBC transfusion in patients undergoing elective infrarenal aortic operations. METHODS In a single blind, multicenter trial, 72 patients were prospectively randomized two-to-one to HBOC (n = 48) or allogenic RBC (n = 24) at the time of the first transfusion decision, either during or after elective infrarenal aortic reconstruction. Patients randomized to the HBOC group received 60 g of HBOC for the initial transfusion and had the option to receive three more doses (30 g each) within 96 hours. In this group, any further blood requirement was met with allogenic RBCs. Patients randomized to the allogenic RBC group received only standard RBC transfusions. The efficacy analysis was a means of assessing the ability of HBOC to eliminate the requirement for any allogenic RBC transfusions from the time of randomization through 28 days. Safety was evaluated by means of standard clinical trial methods. RESULTS The two treatment groups were comparable for all baseline characteristics. Although all patients in the allogenic RBC group required at least one allogenic RBC transfusion, 13 of 48 patients (27%; 95% CI, 15% to 42%) in the HBOC group did not require any allogenic RBC transfusions. The only significant changes documented were a 15% increase in mean arterial pressure and a three-fold peak increase in serum urea nitrogen concentration after HBOC. The complications were similar in both groups, with no allergic reactions. There were two perioperative deaths (8%) in the allogenic RBC group and three perioperative deaths (6%) in the HBOC group (P = 1.0). CONCLUSION HBOC significantly eliminated the need for any allogenic RBC transfusion in 27% of patients undergoing infrarenal aortic reconstruction, but did not reduce the median allogenic RBC requirement. HBOC transfusion was well tolerated and did not influence morbidity or mortality rates.