Non-pharmacological strategies for blood conservation in cardiac surgery

Purpose: Of all surgical specialties, cardiac operations are most often ass ociated with coagulopathy, blood loss, and the need for transfusions. This not only represents a major burden on blood procurement and banking organiz ations at ail levels, but also constitutes a risk for each patient receivin g allogeneic blood products. This paper reviews current non-pharmacological strategies aimed at decreasing blood use in patients undergoing cardiac su rgery. Source: The literature pertaining to each blood conservation strategy was s earched, reviewed, and appraised. Meta- analyses were also consulted and th eir results complemented with subsequent reports when available. Principal findings: Preoperative autologous donation programs are effective in decreasing allogeneic transfusions, but are costly and applicable to el ective patients only. Off-pump revascularization strategies also appear to decrease transfusion requirements in suitable patients. The effectiveness o f acute normovolemic hemodilution, retrograde autologous priming. small vol ume cardiopulmonary bypass circuits, platelet-rich plasmapheresis, alternat ive heparin strategies, and postoperative cell salvage are more difficult t o appraise as a high proportion of available studies suffer from lack of tr ansfusion guidelines or the absence of blinding, Biological glues, surgical adhesives, and postoperative increases in positive end-expiratory, pressur e (PEEP) have no demonstrated efficacy. Conclusion: The applicability or effectiveness of many of these modalities remains controversial and more studies are needed before they may be employ ed routinely in cardiac surgical patients. The judicious use of rational tr ansfusion guidelines may still be the simplest and most cost-effective mean s of blood conservation today.