Abstract
Cardiac surgery is associated with high risk of perioperative blood loss leading to hemodynamic instability, which frequently warrants fluid replacement, pharmacological therapy or transfusion. Regardless of an association of as little as 1-2 blood units with a dramatic increase in morbidity and mortality, transfusion is still widely administered. Despite recent guidelines there is still little consensus on blood transfusion thresholds and the implementation of multidisciplinary patient blood management programs, has not led to convincing effects as RBC transfusion is still a frequent option in cardiac surgery.
Highlights
Cardiac surgery, due to the complexity of the procedures, is associated with high risk of perioperative blood loss [110], especially in patients with advanced age and long cardiopulmonary bypass (CPB) [9,10]
Despite the fact that transfusion of as little as 1 or 2 units of red blood cells (RBC) has been associated with a dramatic increase in morbidity, mortality and costs in patients undergoing cardiac surgery [8,17], blood transfusion is still performed as rescue therapy before the decision of re-exploration is made
Optimization of the haemoglobin (Hb) level has always been the primary focus while initiating blood transfusions [19,23,28,29,30,31,32,33,34] with less attention to the fact that haemoglobin is one of the factors of the relatively simple algorithm determine oxygen delivery, which includes haemoglobin level, cardiac output (CO) and arterial saturation (SAT) (Figure 1)
Summary
Due to the complexity of the procedures, is associated with high risk of perioperative blood loss [110], especially in patients with advanced age and long cardiopulmonary bypass (CPB) [9,10]. Despite new guidelines [18,19], there is still little consensus on what constitutes a massive blood transfusion and thresholds might be associated with adverse outcomes [20,21] and the issue might be, as pointed out in a following editorial, that there was “Something for Almost Everyone” [22]. This is in contrast to earlier ASA guidelines from 1996 [23], and actual guidelines from the Danish Health and Medicine Authority’s [24], which firmly declare lower thresholds for transfusion. The later ASA guidelines handled broader aspects of blood management programs the specific recommendations of RBC transfusion was less visible [25,26] and the overall result of the efforts is not convincing as RBC transfusion is still a frequent option in cardiac surgery [7,27]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
