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Are we doing everything we can to conserve blood during bypass? A national survey.

https://arctichealth.org/en/permalink/ahliterature172391
Source
Perfusion. 2005 Sep;20(5):237-41
Publication Type
Article
Date
Sep-2005
Author
D. Belway
F D Rubens
D. Wozny
B. Henley
H J Nathan
Author Affiliation
Division of Perfusion Services, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Source
Perfusion. 2005 Sep;20(5):237-41
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Blood Loss, Surgical - prevention & control
Blood Transfusion, Autologous - methods - utilization
Canada
Cardiopulmonary Bypass - methods
Centrifugation
Data Collection
Filtration
Humans
Leukocyte Reduction Procedures
Abstract
Despite major advances in biomaterial research and blood conservation, bleeding is still a common complication after cardiopulmonary bypass and cardiac surgery remains a major consumer of blood products. Although the underlying mechanisms for these effects are not fully established, two proposed major etiologies are the hemodilution associated with the use of the heart-lung machine and the impact of reinfusion of shed cardiotomy blood. Therapeutic strategies that primarily encompass the use of devices or technologies to overcome these effects may result in improved clinical outcomes.
To determine the extent to which 1) lipid/leukocyte filtration and centrifugal processing of cardiotomy blood, and 2) modified ultrafiltration (MUF) are currently applied in adult cardiac surgery in Canada.
A questionnaire was mailed to the chief perfusionist at all adult cardiac surgical centers in Canada, addressing details regarding the frequency of use of cardiotomy blood processing and MUF.
All questionnaires (36, 100%) were completed and returned. With regards to cardiotomy blood management, in 21 centers (58%), no specific processing steps were utilized exclusive of the integrated cardiotomy reservoir filter. Of the remaining centers, two (6%) reported using lipid/leukocyte filtration and 15 (42%) reported washing their cardiotomy blood. Three centers (8%) reported using MUF at the end of CPB.
Despite growing concern about the potential detrimental effects of cardiotomy blood, few centers in Canada routinely manage this blood with additional filtration and/or centrifugal processing prior to reinfusion. Similarly, MUF, demonstrated to be effective in the pediatric population, has not seen popular application in adult cardiac surgical practice.
PubMed ID
16231618 View in PubMed
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A decision aid for autologous pre-donation in cardiac surgery--a randomized trial.

https://arctichealth.org/en/permalink/ahliterature173793
Source
Patient Educ Couns. 2006 Jun;61(3):458-66
Publication Type
Article
Date
Jun-2006
Author
A. Laupacis
A M O'Connor
E R Drake
F D Rubens
J A Robblee
F C Grant
P S Wells
Author Affiliation
Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, Ont., Canada M4N 3M5. alaupacis@ices.on.ca
Source
Patient Educ Couns. 2006 Jun;61(3):458-66
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude to Health
Blood Transfusion, Autologous - adverse effects - psychology
Cardiac Surgical Procedures - adverse effects - education - psychology
Choice Behavior
Conflict (Psychology)
Decision Support Techniques
Educational Measurement
Female
Follow-Up Studies
Health Knowledge, Attitudes, Practice
Humans
Informed consent
Male
Middle Aged
Ontario
Patient Education as Topic - methods - standards
Preoperative Care - psychology
Risk assessment
Role
Abstract
The objective of this randomized, controlled study was to determine the usefulness of a decision aid on pre-donation of autologous blood before elective open heart surgery.
The decision aid (DA) group received a tape and booklet which described the options for peri-operative transfusion in detail. The no decision aid (NDA) group received information usually given to patients about autologous donation.
A total of 120 patients were randomized. The DA group rated themselves better prepared for decision making and showed significant improvements in knowledge (p = 0.001) and realistic risk perceptions (p = 0.001). In both groups there was an increase in the proportion of patients choosing allogeneic blood between baseline and follow-up (p = 0.001). Patients in the DA group were significantly more satisfied with the amount of information they received, how they were treated and with the decision they made, than patients in the NDA group.
The decision aid is useful in preparing patients for decision making.
The next stage is to explore strategies to make it available to all appropriate patients.
PubMed ID
16024212 View in PubMed
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Temperature management and monitoring practices during adult cardiac surgery under cardiopulmonary bypass: results of a Canadian national survey.

https://arctichealth.org/en/permalink/ahliterature134381
Source
Perfusion. 2011 Sep;26(5):395-400
Publication Type
Article
Date
Sep-2011
Author
D. Belway
R. Tee
H J Nathan
F D Rubens
M. Boodhwani
Author Affiliation
Department of Perfusion Services, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Source
Perfusion. 2011 Sep;26(5):395-400
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Body temperature
Canada
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Data Collection
Female
Humans
Hypothermia - etiology - physiopathology
Male
Monitoring, Intraoperative - methods
Abstract
Mild to moderate systemic hypothermia is commonly used as a cerebral protective strategy during adult cardiac surgery. The benefits of this strategy for routine cardiac surgery have been questioned and the adverse effects of hyperthermia demonstrated. The purpose of the present study was to examine current temperature management and monitoring practices during adult cardiac surgery using CPB in Canada.
Web-based survey referring to adult cases undergoing cardiac surgery using CPB without the use of deep hypothermic circulatory arrest. Thirty-two questionnaires were completed, representing a 100% response rate.
The usual management is to cool patients during CPB at 30 (94%) centers for low-risk (isolated primary CABG) cases and at 31 (97%) centers for high-risk (all other) cases. The average nadir temperature at the target site achieved on CPB is 34°C (range 28°C - 36°C). At 26 (81%) centers, patients are typically rewarmed to a target temperature between 36°C and 37°C before separation from CPB. Only 6 (19%) centers reported that thermistors and coupled devices used to monitor blood temperature are checked for accuracy or calibrated according to the product operating directive's schedule or more often.
Contemporary management of adult cardiac surgery under CPB still involves induction of mild to moderate systemic hypothermia. Significant practice variation exists across the country with respect to target temperatures for cooling and rewarming, as well as the site for temperature monitoring. This probably reflects the lack of definitive evidence. There is a need for well-conducted clinical trials to provide more robust evidence regarding temperature management.
PubMed ID
21593083 View in PubMed
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