Abstract
About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse short- and long-term outcomes. Recommendations and guidelines on the topic are published in an increasing rate. The concept aims at using an evidence-based approach to rationalize transfusion practices by optimizing the patient’s red blood cell mass in the pre-, intra- and postoperative periods. However, elegant as a concept, the implementation of a PBM program on an institutional level or even in a single surgical discipline like cardiac surgery, can be easier said than done. Many barriers, such as dogmatic ideas, logistics and lack of support from the medical and administrative departments need to be overcome and each center must find solutions to their specific problems. In this paper we present a narrative overview of the challenges and updated recommendations for the implementation of a PBM program in cardiac surgery.
Highlights
The Scope of the ProblemCardiac surgery is a generic term for various types of major surgery performed on the heart and great vessels, usually performed on cardiopulmonary bypass (CPB) with full systemic anticoagulation
The following paragraph resumes the intraoperative measures of Patient Blood Management (PBM) recommended in the 2019 joint guidelines [77] on cardiopulmonary bypass in adult cardiac surgery form the European Association for Cardiothoracic Surgery (EACTS), the European Association of Cardiothoracic Anesthesiologists (EACTA) and the Board of Cardiovascular Perfusionists (EBPC) and the 2017 EACTA/EACTS guidelines [7] on patient blood management for adult cardiac surgery
Unfractionated heparin is the anticoagulant of choice for cardiac surgery using CPB, and protamine is the antidote administered after CBP weaning
Summary
Valentina Rancati 1, *, Emmanuelle Scala 1 , Zied Ltaief 2 , Mohamed Ziyad Gunga 3 , Matthias Kirsch 3,4 , Lorenzo Rosner 1 and Carlo Marcucci 1,4. Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
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