• 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.

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