Researchers have found that a blood-reduction program in cardiac surgery results in a reduced need for transfusions

Nov 23 2004

Researchers at Virginia Commonwealth University’s Medical Center have found that a blood-reduction program in cardiac surgery is resulting in a reduced need for transfusions without compromising patients’ recoveries.

An observational study in which approximately 1,000 cardiac surgery patients were examined showed that patients in the cardiac blood-reduction program did as well as -- if not better than -- patients who had surgery prior to the implementation of the program.

The blood-reduction program also reduced the reliance on banked blood, lowering the associated storage and equipment costs and freeing it up for patients who really need it. These results were published in the August issue of the Journal of Cardiothoracic and Vascular Anesthesia.

“Recently, there has been increasing scientific evidence suggesting that blood transfusions do not always improve outcomes from surgery,” said Jeffrey Green, M.D., director of cardiothoracic anesthesiology at the VCU Medical Center.

“In fact, the risks of blood transfusion are becoming more widely recognized as contributing to surgical complications, such as organ failure and infections. Our research supports this evidence and it is gradually becoming more accepted by some medical institutions.”

“The VCU Medical Center is implementing a blood-reduction program in many divisions of surgery based on the results of this observational study, and we are currently working to develop the program and expand the conservation techniques and philosophies,” said Green, who is the lead investigator of the study. “A blood-reduction program will enable the medical facility to provide the blood resources to patients who are in desperate need.”

VCU’s Department of Anesthesiology and Division of Cardiac Surgery developed the nine-point, blood-reduction program, which has been used by the cardiac surgical team since 1999.

The blood-reduction program used by Green and his colleagues reduced the need for unnecessary transfusions by using various strategies throughout the entire surgical period, including the use of drugs and blood-salvaging devices. Further, certain anesthesia and surgical techniques that help prevent patients from bleeding were used during surgery, as well as after.

Following surgery, the researchers observed a dramatic reduction in the need for heart stimulating drugs; a reduction in invasive procedures like use of an intra-aortic balloon pump; a reduction of reoperations due to bleeding; and less acute kidney failure.

Implementing a blood-reduction program requires collaboration from all members of the surgical team, Green said. Doctors must tailor the program to fit the needs of different groups of patients. For example, patients with severe cerebral vascular disease and other complicated medical problems would not necessarily tolerate a blood-reduction effort.

“VCU has been recognized as a leader in blood-reduction techniques and bloodless cardiac surgery,” Green said. “We have one of the lowest published transfusion rates for cardiac surgery in the world.”

“We also observed that our cost savings were significant because there was less use of blood,” he said. “At the same time, we observed there was an associated improvement in patient outcomes.”

“Today, blood product costs are on the rise because blood has become a scarce resource. Several centers nationwide have established similar blood-reduction programs” said Green.

Green said that in addition to the cost savings realized by eliminating blood transfusions there is a benefit for those people who want to avoid having a blood transfusion.

“VCU’s program has become of interest to patients of the Jehovah’s Witness faith, who cannot receive blood transfusions,” Green said. “Jehovah Witness leaders have approached our cardiac surgery team and are building strong relationships because they have seen that VCU can perform cardiac surgery with little or no transfusion using various techniques in the program.”

Program collaborators included Green; Robert Higgins, M.D., former chair of cardiac surgery; Abe Deanda, M.D., associate professor of surgery; and Bruce Spiess, M.D., director of anesthesiology research, vice chair of anesthesiology, and director of VCURES Shock Center.