Cardiac Surgical Bleeding, Transfusion, and Quality Metrics: Joint Consensus Statement by the Enhanced Recovery After Surgery Cardiac Society and Society for the Advancement of Patient Blood Management

被引：0

作者：

Salenger, Rawn ^{[1
]}

Arora, Rakesh C. ^{[2
]}

Bracey, Arthur ^{[3
]}

D'Oria, Mario ^{[4
]}

Engelman, Daniel T. ^{[5
]}

Evans, Caroline ^{[6
]}

Grant, Michael C. ^{[7
]}

Gunaydin, Serdar ^{[8
]}

Morton, Vicki ^{[9
]}

Ozawa, Sherri ^{[10
,11
]}

Patel, Prakash A. ^{[12
]}

Raphael, Jacob ^{[13
]}

Rosengart, Todd K. ^{[14
]}

Shore-Lesserson, Linda ^{[15
]}

Tibi, Pierre ^{[16
]}

Shander, Aryeh ^{[10
,11
]}

机构：

[1] Univ Maryland, St Joseph Med Ctr, Div Cardiac Surg, Towson, MD USA

[2] Univ Hosp, Harrington Heart & Vasc Inst, Cleveland, OH USA

[3] Baylor Coll Med, Dept Pathol & Immunol, Houston, TX USA

[4] Univ Trieste, Dept Med Surg & Hlth Sci, Div Vasc & Endovasc Surg, Trieste, Italy

[5] Univ Massachusetts, Baystate Med Ctr, Dept Surg, Chan Med Sch, Springfield, MA USA

[6] Univ Hosp UK, Cardiff, Wales

[7] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[8] Univ Hlth Sci, Dept Cardiovasc Surg, City Hosp Campus, Ankara, Turkiye

[9] Providence Anesthesiol Associates, Charlotte, NC USA

[10] Englewood Hosp, Dept Anesthesiol Crit Care & Hyperbar Med, TeamHlth, 350 Engle St, Englewood, NJ 07631 USA

[11] Soc Adv Patient Blood Management SABM, Englewood, NJ USA

[12] Jefferson Abington Hosp, Dept Gastroenterol, Abington, PA USA

[13] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Anesthesiol & Perioperat Med, Philadelphia, PA 19107 USA

[14] Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX USA

[15] Zucker Sch Med Hofstra Northwell, Dept Anesthesiol, Manhasset, NY USA

[16] Yavapai Reg Med Ctr, Dept Cardiovasc Surg, Prescott, AZ USA

来源：

ANNALS OF THORACIC SURGERY | 2025年 / 119卷 / 02期

关键词：

INTRAOPERATIVE CELL SALVAGE; ACUTE NORMOVOLEMIC HEMODILUTION; FIBRINOGEN CONCENTRATE; CARDIOPULMONARY-BYPASS; RE-EXPLORATION; PROGNOSTIC IMPACT; CORONARY SURGERY; 1ST-LINE THERAPY; TRANEXAMIC ACID; RISK-FACTORS;

D O I：

10.1016/j.athoracsur.2024.06.039

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality, and cost. METHODS An international expert panel was convened to develop consensus statements on the control of bleeding and management of transfusion and to suggest key quality metrics for cardiac surgical bleeding. The panel reviewed relevant literature from the previous 10 years and used a modified RAND Delphi methodology to achieve consensus. RESULTS The panel developed 30 consensus statements in 8 categories, including prioritizing control of bleeding, prechest closure checklists, and the need for additional quality indicators beyond reexploration rate, such as time to reexploration. Consensus was also reached on the need for a universal definition of excessive bleeding, the use of antifibrinolytics, optimal cessation of antithrombotic agents, and preoperative risk scoring based on patient and procedural factors to identify those at greatest risk of excessive bleeding. Furthermore, an objective bleeding scale is needed based on the volume and rapidity of blood loss accompanied by viscoelastic management algorithms and standardized, patient-centered blood management strategies reflecting an interdisciplinary approach to quality improvement. CONCLUSIONS Prioritizing the timely control and management of bleeding is essential to improving patient outcomes in cardiac surgery. To this end, a cardiac surgical bleeding quality metric that is more comprehensive than reexploration rate alone is needed. Similarly, interdisciplinary quality initiatives that seek to implement enhanced quality indicators will likely lead to improved patient care and outcomes. (Ann Thorac Surg 2025;119:280-95) <feminine ordinal indicator> 2025 The Authors. Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：280 / 295

页数：16

共 159 条

[21] Ramirez M., Ramirez Almazan M.A., Lewis K., PSU6 Economic impact of a validated intraoperative bleeding scale: a retrospective multicenter review from the US prospective, Value Health, 22, (2019)
[22] Biancari F., Ruggieri V.G., Perrotti A., Et al., European multicenter study on coronary artery bypass grafting (E-CABG registry): study protocol for a prospective clinical registry and proposal of classification of postoperative complications, J Cardiothorac Surg, 10, (2015)
[23] Vranckx P., White H.D., Huang Z., Et al., Validation of BARC bleeding criteria in patients with acute coronary syndromes: the TRACER trial, J Am Coll Cardiol, 67, pp. 2135-2144, (2016)
[24] van Baarle F., van de Weerdt E.K., Suurmond B., Muller M.C.A., Vlaar A.P.J., Biemond B.J., Bleeding assessment and bleeding severity in thrombocytopenic patients undergoing invasive procedures, Transfusion, 60, pp. 637-649, (2020)
[25] Gaizo D.J.D., Spotnitz W.D., Hoffman R.W., Et al., SPOT GRADE II: clinical validation of a new method for reproducibly quantifying surgical wound bleeding: prospective, multicenter, multispecialty, single-arm study, Clin Appl Thromb Hemost, 26, (2020)
[26] Karkouti K., O'Farrell R., Yau T.M., Beattie W.S., Prediction of massive blood transfusion in cardiac surgery, Can J Anaesth, 53, pp. 781-794, (2006)
[27] Magruder J.T., Belmustakov S., Ohkuma R., Et al., Attributable harm of severe bleeding after cardiac surgery in hemodynamically stable patients, Gen Thorac Cardiovasc Surg, 65, pp. 102-109, (2017)
[28] Ad N., Massimiano P.S., Rongione A.J., Et al., Number and type of blood products are negatively associated with outcomes after cardiac surgery, Ann Thorac Surg, 113, pp. 748-756, (2022)
[29] Marteinsson S.A., Heimisdottir A.A., Axelsson T.A., Et al., Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes, Scand Cardiovasc J, 54, pp. 265-273, (2020)
[30] Spadaccio C., Rose D., Nenna A., Taylor R., Bittar M.N., Early re-exploration versus conservative management for postoperative bleeding in stable patients after coronary artery bypass grafting: a propensity matched study, J Clin Med, 12, (2023)

← 1 2 3 4 5 6 7 8 9 10 →