Earlier this year, on June 30th, the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists, in partnership with other organizations, released updated blood conservation clinical practice guidelines addressing an evidenced-based, multi-modal, and multi-disciplinary approach to conserving blood resources, in addition to optimizing outcomes in patients at high risk for transfusion. These guidelines have not been updated since 2011, and over the last decade, so much has changed in terms of technology and technique, allowing for more minimally-invasive procedures to lessen the need for in-surgery blood transfusion.
In the past, this process was referred to as “blood conservation,” however, the term has broadened to “patient blood management” (PBM), which includes conserving blood, but also assessing the full scope of this aspect of care for cardiac surgical patients – considering ways to better manage any patient conditions before surgery to in general reduce the need for blood transfusion.
The new guideline features 23 new or updated recommendations related to these four basic components:
- Managing anemia
- Optimizing coagulation
- Interdisciplinary blood conservation modalities
- Patient-centered decision-making to achieve quality outcomes
Evidence has shown that perioperative blood transfusion in cardiac surgery has been linked to an increase in postoperative morbidity and mortality. One main component of blood conservation is the tolerance of perioperative anemia, and studies have shown that perioperative anemia does not necessarily increase the risk of complications or death in cardiac surgery, but rather, avoidance of transfusion altogether reduces the risk.
This is just one example of how clear understanding of all clinical and operational components of this aspect of a full-service CV program can impact all other components in either a positive or negative way. In fact, consistency in blood management can be a driver of quality of care; can assist in meeting or exceeding standards for accreditation, licensures, or certification; and can lead to improved clinical outcomes for ALL patients when standards are followed and deviations are quickly addressed.
Certainly, blood transfusions are a critical and important life-saving clinical intervention when caring for cardiothoracic surgical patients. Many stakeholders are involved with care throughout the course of treatment, and many Class I recommendations have been developed based on thought leadership from experts from diverse clinical and quality groups and associations that they hope will be received as reasonable and well researched. These Class I recommendations address:
- Preoperative Interventions
- Preoperative antiplatelet management
- Preoperative anticoagulants
- Pharmacologic agents
- Blood products and derivatives
- Perfusion interventions
- Blood salvage interventions
- Postoperative fluid management
- Transfusion algorithms
- Management of blood resources
Establishment of a multidisciplinary blood conservation program can significantly control blood transfusion rates while improving outcomes AND reducing cost. It is important to implement evidenced-based protocols to help in standardization and decreased blood usage in cardiac surgery, and better manage patients as a whole during the entire continuum of care, which will likely decrease transfusion rates along with the risk of side effects.
In fact, a PBM program has been shown to reduce transfusion rates by as much as 45%. To more clearly understand your clinical and operational processes related to blood conservation and surgical patient management, reach out to Corazon – our program assessments can reveal opportunities to improve here and elsewhere within CV surgery – to optimize outcomes and patient results at any point along the care continuum.
The entire article explaining the updated guidelines can be found by searching for
STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management.