Features  |   September 2016
Point-of-Care Testing for Hemostasis After Cardiac Surgery With Cardiopulmonary Bypass
Author Affiliations
  • Jacob Raphael, M.D.
    Committee on Cardiovascular and Thoracic Anesthesia
  • Linda Shore-Lesserson, M.D., FAHA, FASE
    Committee on Cardiovascular and Thoracic Anesthesia
  • Gregory M. Janelle, M.D., FASE
    Committee on Cardiovascular and Thoracic Anesthesia
    Chair
Article Information
Cardiovascular Anesthesia / Coagulation and Transfusion / Hematologic System / Technology / Equipment / Monitoring / Features
Features   |   September 2016
Point-of-Care Testing for Hemostasis After Cardiac Surgery With Cardiopulmonary Bypass
ASA Monitor 09 2016, Vol.80, 12-14.
ASA Monitor 09 2016, Vol.80, 12-14.
Cardiopulmonary bypass-induced coagulopathy is a serious complication that may result in massive bleeding requiring transfusion of multiple units of red blood cells and pro-coagulant products. Up to 10 percent of cardiac surgery patients suffer from massive blood loss (chest tube bleeding >2,000 ml over the first 24 hours after surgery, or the need to transfuse 10 red blood cell [RBC] units, or more, over a 24-hour period)1  and up to 5 percent of all patients having cardiac surgery require emergent chest re-exploration to achieve hemostasis.2  Thus, timely control of coagulopathy is of prime importance in order to avoid the sequelae of excessive bleeding. A significant body of evidence has associated allogeneic blood transfusions during cardiac surgery with increased risk of perioperative complications and mortality.3  Despite this evidence base, and despite the publication of transfusion guidelines,4,5  transfusions still occur in 50 percent of cardiac surgery patients.6  The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists Guidelines for Blood Conservation in Cardiac Surgery7  suggest a class I recommendation for “A multimodality approach involving multiple stakeholders, institutional support, enforceable transfusion algorithms supplemented with point-of-care testing, and all of the already mentioned efficacious blood conservation interventions will limit blood transfusion and provide optimal blood conservation for cardiac operations.” (level of evidence A).
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