Use of Intraoperative Hemostatic Checklists for Blood Management in Patients Undergoing Cardiac Surgery: A Scoping Review

Abstract

Background

Using intraoperative hemostatic checklists may improve rates of surgical re-exploration and utilization of allogenic blood products in patients undergoing cardiac surgery. In this review, the authors explore the current evidence describing the impact of using intraoperative hemostatic checklists on reducing rates of surgical bleeding and perioperative blood product transfusion in this group of patients.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic information was obtained via sources that included Scopus, MEDLINE, EMBASE, and the Cochrane Library. Specifically, randomized controlled and observational studies reporting on hemostatic checklists in cardiac surgery were assessed for the following inclusion criteria: adult patients undergoing cardiac surgery, use of an intraoperative hemostatic checklist, a comparative study design, and full text available in the English language. All conference abstracts, editorials, and other reviews were excluded.

Results

A total of 3,022 articles were retrieved. Four articles, with 19,946 patients, were ultimately included in this review. These studies showed a significant reduction in bleeding re-exploration rates after implementing an intraoperative hemostatic checklist. In addition, three studies showed lower cost per patient, less blood product transfusion, and reduced intensive care unit stay after using checklists.

Conclusions

These findings suggest that using intraoperative hemostatic checklists may reduce surgical re-exploration rates and improve blood product utilization after cardiac surgery. Large multicenter studies are needed to endorse the utilization of these checklists in routine clinical practice.