Current State of Patient Blood Management in Cardiovascular Surgery: Insights from a Survey of Leading Centers.

Abstract

Objective: To determine the state of patient blood management (PBM) practice in leading US cardiac surgery centers.

Design: A survey tool addressing PBM program structure and PBM program operations was deployed. The survey also incorporated practice in managing certain case scenarios.

Setting: Cardiac surgery centers.

Intervention: None.

Participants: The US News and World Reports 2024 top 25 cardiac surgery centers.

Measurements and main results: Only 29% of sites had full-time equivalents committed to PBM. The approach to informed consent varied among sites. Most sites (54%) obtained informed consent to cover the entire hospital stay. Consent for non-emergent transfusion was obtained at 21% of sites. Preadmission anemia screening was deployed for longer than 2 weeks in 29% of sites. While many anesthesia techniques associated with blood conservation were used by the majority (e.g., acute normovolemic hemodilution 92%, retrograde autologous priming 95%), simple steps like adjusting cardiopulmonary (CPB) circuits for patient size were only offered at 43% of sites.

Conclusions: Key features of well-designed PBM programs were not found in many of the surveyed programs. This audit suggests an opportunity for PBM growth across cardiovascular surgery programs.