Utilization of technologies to reduce allogeneic blood transfusion in the United States

Concern over safety of the blood supply has led to the use of technologies to reduce allogeneic blood transfusion. The objective of this research was to determine the utilization of these technologies in the United States. We evaluated the following techniques: preoperative autologous donation (PAD) , cell salvage (CS) and acute normovolemic haemodilution (ANH); and the fol lowing pharmaceuticals: aprotinin (APR), epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), desmopressin (DDAVP) and recombinant human erythropo ietin (EPO). In 1997, we conducted a cross-sectional mail survey of service chiefs at 1000 US hospitals randomly selected and stratified by status as a provider of open-heart surgery, geographical location and hospital bed si ze. Sixty-nine per cent (690) of hospitals responded to at least one of the four surveys sent to each hospital. Hospitals reported use of techniques m ore than pharmaceuticals (P < 0.001); PAD (83%, n = 206) and CS (82% n = 42 0) were used most frequently. Lack of familiarity was the most common reaso n cited for infrequent use of pharmaceuticals. Organizational characteristi cs (e.g. provision of open-heart surgery, size, geographical location, teac hing status and type of hospital) were differentially associated with techn ology use. There is greater use of techniques than pharmaceuticals in US ho spitals to reduce the need for allogeneic blood in the peri-operative setti ng. Providing open-heart surgery is strongly associated with the utilizatio n of these technologies.