• Laura Baker, Lily Park, Richard Gilbert, Hilalion Ahn, Andre Martel, Tori Lenet, Alexandra Davis, Daniel I McIsaac, Alan Tinmouth, Dean A Fergusson, and Guillaume Martel.
• Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
• Ann. Surg. 2021 Jul 1; 274 (1): 869686-96.

ObjectivesThe objective of this work was to carry out a systematic review of clinical practice guidelines (CPGs) pertaining to intraoperative red blood cell (RBC) transfusions, in terms of indications, decision-making, and supporting evidence base.Summary Of Background DataRBC transfusions are common during surgery and there is evidence of wide variability in practice.MethodsMajor electronic databases (MEDLINE, EMBASE, and CINAHL), guideline clearinghouses and Google Scholar were systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative RBC transfusion. Eligible guidelines were retrieved and their quality assessed using AGREE II. Relevant recommendations were abstracted and synthesized to allow for a comparison between guidelines.ResultsTen guidelines published between 1992 and 2018 provided indications for intraoperative transfusions. No guideline addressed intraoperative transfusion decision-making as its primary focus. Six guidelines provided criteria for transfusion based on hemoglobin (range 6.0-10.0 g/dL) or hematocrit (<30%) triggers. In the absence of objective transfusion rules, CPGs recommended considering other parameters such as blood loss (n = 7), signs of end organ ischemia (n = 5), and hemodynamics (n = 4). Evidence supporting intraoperative recommendations was extrapolated primarily from the nonoperative setting. There was wide variability in the quality of included guidelines based on AGREE II scores.ConclusionThis review has identified several clinical practice guidelines providing recommendations for intraoperative transfusion. The existing guidelines were noted to be highly variable in their recommendations and to lack a sufficient evidence base from the intraoperative setting. This represents a major knowledge gap in the literature.Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.

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