Blood conservation in cardiac surgery

Abstract

Cardiac surgery consumes more blood products than any other field of medicine. Blood product transfusions are used to prevent anemia-related tissue hypoxia and correct coagulopathy. Direct harm associated with transfusions has been greatly decreased due to infection control and leukoreduction. However, there is growing evidence concerning the indirect effects resulting in transfusion-related acute lung injury, transfusion-associated cardiac overload, and transfusion-related immunomodulation, which are associated with higher morbidity and mortality. Approximately half of all cardiac surgeries result in transfusion, but there are wide discrepancies in transfusion rates among cardiac surgical centers. There is a need for uniform modern blood conservation guidelines. Implementation of blood conservation strategies has been shown to decrease transfusion rates, improve outcomes, and reduce costs. In this chapter, we discuss pre-, intra-, and postoperative strategies, which include autologous donation, use of acute normovolemic hemodilution and fibrinolytics, effects of surgical and cardiopulmonary bypass factors, use of retrograde autologous prime and cell salvage, advantages of point of care testing, and evidence in support of restrictive transfusion strategies.