• J Clin Anesth · Nov 2024

    Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion.

    • Hélène Charbonneau, Stéphanie Savy, Nicolas Savy, Marie Pasquié, Nicolas Mayeur, CP-PBM Study Group, Olivier Angles, Vincent Balech, Anne-Laure Berthelot, Madeleine Croute-Bayle, Isabelle Decramer, David Duterque, Valerie Julien, Laurent Mallet, Mimoun M'rini, Jean-François Quedreux, Benoit Richard, Laurent Sidobre, Laurence Taillefer, Adrien Thibaud, Issam Abouliatim, Pierre Berthoumieu, Olivier Garcia, Philippe Soula, Olivier Vahdat, Claude Breil, Pierre Brunel, and Giovanni Sciacca.
    • Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, Toulouse, France. Electronic address: hcharbonneau@clinique-pasteur.com.
    • J Clin Anesth. 2024 Nov 1; 98: 111560111560.

    Study ObjectiveThe aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.DesignProspective, non-randomized, two-step protocol design.SettingCardiac surgery department of Clinique Pasteur, Toulouse, France.Patients897 patients undergoing for elective CPB surgery.InterventionsWe conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.MeasurementsThe PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.Main ResultsAfter matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44-0.79] and 0.44 [95% CI 0.32-0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.ConclusionsThis study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.Copyright © 2024 Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…