Featured Research

from universities, journals, and other organizations

Restrictive use of blood transfusions during cardiac surgery shows comparable outcomes

Date:
October 12, 2010
Source:
JAMA and Archives Journals
Summary:
Use of stricter guidelines for the use of red blood cell transfusions for patients undergoing cardiac surgery was associated similar rates of death and severe illness compared to patients who received more transfusions, according to a new study.

Use of stricter guidelines for the use of red blood cell transfusions for patients undergoing cardiac surgery was associated similar rates of death and severe illness compared to patients who received more transfusions, according to a study in the October 13 issue of JAMA.

Cardiac surgery is associated with a high rate of blood transfusion. The rationale for red blood cell (RBC) transfusion is based on the observation that anemia is an independent risk factor for illness and death after cardiac operations. However, transfusions have been associated with high rates of these poor outcomes in critically ill patients, and some recent studies have shown worse outcomes compared with nontransfused patients after cardiac surgery, according to background information in the article. "There is a lack of evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery," the authors write.

Ludhmila A. Hajjar, M.D., Ph.D., of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil, and colleagues conducted the Transfusion Requirements After Cardiac Surgery (TRACS) study to examine whether a restrictive strategy of RBC transfusion was as safe as a liberal strategy in patients undergoing elective cardiac surgery. The randomized clinical trial was conducted between February 2009 and February 2010 in an intensive care unit (ICU) at a university hospital cardiac surgery referral center in Brazil and included 502 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were randomly assigned to a liberal strategy of blood transfusion (to maintain a hematocrit [the volume percentage of red blood cells in whole blood] of 30 percent or greater) or to a restrictive strategy (hematocrit 24 percent or greater). The overall average hematocrit values in the ICU were 31.8 percent in the liberal-strategy group and 28.4 percent in the restrictive-strategy group.

A total of 198 of 253 patients (78 percent) in the liberal-strategy group and 118 of 249 (47 percent) in the restrictive-strategy group received a blood transfusion. The researchers found that the primary composite outcome measured at 30 days -- death from any cause, cardiogenic shock, acute respiratory distress syndrome, or acute renal injury requiring dialysis or hemofiltration during the hospital stay -- occurred in 10 percent of patients in the liberal-strategy group and in 11 percent in the restrictive-strategy group. Independent of transfusion strategy, the number of transfused red blood cell units was an independent risk factor for clinical complications or death at 30 days.

There were no significant differences in the occurrence of cardiac, respiratory, neurologic, or infectious complications, or severe bleeding requiring reoperation. There were also no differences in lengths of ICU or hospital stay.

The authors suggest that the rationale for implementing a restrictive transfusion strategy is based on many studies that have shown a lack of benefit and, at the same time, substantially increased costs and adverse effects associated with RBC transfusion, including transmission of viral and bacterial diseases and transfusion-related acute lung injury.

Editorial: Blood Transfusion as a Quality Indicator in Cardiac Surgery

In an accompanying editorial, Aryeh S. Shander, M.D., of Englewood Hospital and Medical Center, Englewood, N.J., and Lawrence T. Goodnough, M.D., of the Stanford University School of Medicine, Stanford, Calif., comment on the findings of this study.

"The study by Hajjar et al is a notable addition to the existing body of evidence on the narrow benefits of RBC transfusion and its effect on outcomes in patients without hemorrhage. These studies have suggested that reduction or avoidance of transfusion in cardiac patients is associated with improved outcomes. … the trial by Hajjar et al showed that patients undergoing cardiac surgery who received fewer RBC transfusions did as well as those transfused more liberally, with no evidence of ischemia or impaired delivery of oxygen to tissues."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. L. A. Hajjar, J.-L. Vincent, F. R. B. G. Galas, R. E. Nakamura, C. M. P. Silva, M. H. Santos, J. Fukushima, R. K. Filho, D. B. Sierra, N. H. Lopes, T. Mauad, A. C. Roquim, M. R. Sundin, W. C. Leao, J. P. Almeida, P. M. Pomerantzeff, L. O. Dallan, F. B. Jatene, N. A. G. Stolf, J. O. C. Auler. Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 2010; 304 (14): 1559 DOI: 10.1001/jama.2010.1446
  2. A. S. Shander, L. T. Goodnough. Blood Transfusion as a Quality Indicator in Cardiac Surgery. JAMA: The Journal of the American Medical Association, 2010; 304 (14): 1610 DOI: 10.1001/jama.2010.1483

Cite This Page:

JAMA and Archives Journals. "Restrictive use of blood transfusions during cardiac surgery shows comparable outcomes." ScienceDaily. ScienceDaily, 12 October 2010. <www.sciencedaily.com/releases/2010/10/101012163251.htm>.
JAMA and Archives Journals. (2010, October 12). Restrictive use of blood transfusions during cardiac surgery shows comparable outcomes. ScienceDaily. Retrieved April 23, 2014 from www.sciencedaily.com/releases/2010/10/101012163251.htm
JAMA and Archives Journals. "Restrictive use of blood transfusions during cardiac surgery shows comparable outcomes." ScienceDaily. www.sciencedaily.com/releases/2010/10/101012163251.htm (accessed April 23, 2014).

Share This



More Health & Medicine News

Wednesday, April 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Big Pharma Braces for M&A Wave

Big Pharma Braces for M&A Wave

Reuters - Business Video Online (Apr. 22, 2014) Big pharma on the move as Novartis boss, Joe Jimenez, tells Reuters about plans to transform his company via an asset exchange with GSK, and Astra Zeneca shares surge on speculation that Pfizer is looking for a takeover. Joanna Partridge reports. Video provided by Reuters
Powered by NewsLook.com
How Smaller Plates And Cutlery Could Make You Feel Fuller

How Smaller Plates And Cutlery Could Make You Feel Fuller

Newsy (Apr. 22, 2014) NBC's "Today" conducted an experiment to see if changing the size of plates and utensils affects the amount individuals eat. Video provided by Newsy
Powered by NewsLook.com
How to Master Motherhood With the Best Work/Life Balance

How to Master Motherhood With the Best Work/Life Balance

TheStreet (Apr. 22, 2014) In the U.S., there are more than 11 million couples trying to conceive at any given time. From helping celebrity moms like Bethanny Frankel to ordinary soon-to-be-moms, TV personality and parenting expert, Rosie Pope, gives you the inside scoop on mastering motherhood. London-born entrepreneur Pope is the creative force behind Rosie Pope Maternity and MomPrep. She explains why being an entrepreneur offers the best life balance for her and tips for all types of moms. Video provided by TheStreet
Powered by NewsLook.com
Catching More Than Fish: Ugandan Town Crippled by AIDS

Catching More Than Fish: Ugandan Town Crippled by AIDS

AFP (Apr. 22, 2014) The village of Kasensero on the shores of Lake Victoria was where HIV-AIDS was first discovered in Uganda. Its transient population of fishermen and sex workers means the nationwide programme to combat the virus has had little impact. Duration: 02:30 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins