A European survey of patient blood management practice in cardiac surgery

Abstract

Introduction To describe PBM practices in cardiac surgery in 9 European countries and formulate an expert opinion on the identification and management of main risk factors for bleeding or transfusion. Methods Online survey addressing PBM practices in 2 clinical situations, risk factors, and previous experience with antifibrinolytics; enriched by expert opinion. Results In a non-emergency situation, no respondents would make use of preoperative red blood cell transfusion in an anaemic patient, while cell salvage (89%) and antifibrinolytics (82%) would almost always be used. Haemoglobin level optimization (36%) and use of off-pump techniques (34%), minimally invasive surgery (25%) and modern CPB technologies (mini-bypass:32%; autologous priming: 38%) varied greatly across countries. In an emergency clinical situation, topical haemostatic agents would frequently be used (61%). Tranexamic acid (72%) and aprotinin (20%) were the main antifibrinolytics used, with chosen procedures for aprotinin varying across countries. 5 factors were considered at high risk for bleeding or transfusion by at least 90% of respondents: pre-operative anaemia, prior cardiac surgery, clopidogrel 5 days or less before surgery, use of other P2Y12 inhibitors at any point, and thrombocytopenia Conclusion PBM guidelines are not always implemented in European cardiac surgery centres, resulting in discrepancies in techniques and products used for a given clinical situation. Main risk factors identified in the survey and by the expert opinion matched.