Patient Blood Management in cardiac surgery – a contradiction?

Patient blood management (PBM) is well known since its implementation in four German university hospitals and the foundation of the German PBM network. To what extent PBM can be performed in cardiac surgery is the main topic of this review article. The indications for red blood cell transfusions according to current guidelines and recently published studies are discussed. Preoperative, intraoperative and postoperative PBM measures are set in the specific context of cardiac surgery and treatment recommendations are given at the end of the article. Signs of anemic hypoxia are always an indication for transfusion of red blood cells. Guidelines recommend a red blood cell transfusion in patients with acute coronary syndrome and hemoglobin (Hb) levels <7 g/dl, otherwise within the range of 6–8 g/dl. Preoperative therapy of anemia with intravenous iron can be recommended according to current evidence. The time between intravenous iron substitution and surgery should be as long as possible with a minimum of 4 days, a duration that is hardly practicable in cardiac surgery. In contrast, postoperative intravenous iron substitution cannot be recommended, as studies on cardiac surgery patients with postoperative substitution did not result in an increase in Hb levels or a reduction of the red blood cell transfusion rate. Perioperative measures of PBM, such as the use of Cell Saver®, tranexamic acid and point-of-care diagnostics to optimize coagulation are recommendable components of PBM that can easily be performed in cardiac surgery. To summarize, PBM and cardiac surgery do not represent a contradiction but show good compatibility. © 2016, Springer-Verlag Berlin Heidelberg.