Strategy of transfusion in cardiac surgery: limits of hematocrit and how much is too low?
The use of blood and blood products in cardiac surgery is higher than necessary and a reduction is imperative due to complications and costs. Hemodilution is unavoidable in cardiopulmonary bypass and is the most likely pitfall when evaluating transfusion needs. Even patients with coexisting cardiovascular diseases tolerate perioperative hemodilution better than most anticipate. Hemodynamic monitoring is important to evaluate the association between hemoglobin level and organ function. Use of both mechanical and medical blood conservation strategies is required to reduce blood transfusion, and most of the methods have a positive cost-effectiveness and cost-benefit. By using the right strategy and policy, transfusion of blood and blood products can be reduced to less than 5% of cardiac patients.
Aarhus University Hospital, Department of Anesthesia & Intensive Care, Skejby Sygehus, DK-8200, Aarhus N, Denmark. cjj@dadlnet.dk
Carl-Johan
CJ
Jakobsen