• Aryeh Shander, James Brown, Marc Licker, David C Mazer, Jens Meier, Sherri Ozawa, Pierre R Tibi, Phillipe Van der Linden, and Seth Perelman.
• TeamHealth Research Institute, Englewood, NJ; Englewood Health, Englewood, NJ; Icahn School of Medicine, New York, NY; Rutgers University, Newark, NJ. Electronic address: Aryeh.Shander@EHMCHealth.org.
• J. Cardiothorac. Vasc. Anesth. 2020 Jul 1; 34 (7): 1755-1760.

ObjectiveTo develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB).DesignA 2-round modified RAND-Delphi consensus process.ParticipantsSeven physicians from multiple geographic locations and clinical disciplines including anesthesiology and cardiac surgery and 1 cardiac surgery perfusionist participated in the survey. One registered nurse, specializing in Patient Blood Management, participated in the discussion but did not participate in the survey.MethodsA modified RAND-Delphi method was utilized that integrated evidence review with a face-to-face expert multidisciplinary panel meeting, followed by repeated scoring using a 9-point Likert scale. Consensus was determined as a result from the second round survey, as follows: median rating of 1-3: ANH acceptable; median rating of 7-9: ANH not acceptable; median rating of 4-6: use clinical judgment.ResultsEvidentiary review identified 18 key peer-reviewed manuscripts for discussion. Through the consensus-building process, 39 statements including 26 contraindications to ANH and 10 CPB patient variables were assessed. In total, 22 statements were accepted or modified for the second scoring round.ConclusionsConsensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.Copyright © 2020. Published by Elsevier Inc.

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