Transfusion in Cardiopulmonary Bypass. Blood Use & Cardiac Surgery 1971 – average 8 units RBC per case Late 1980’s – Texas Heart Institute 1.4 units per.

Slides:

Advertisements

Similar presentations

Coagulopathy and blood component transfusion in trauma

Advertisements

Off pump CABG has been performed for the first time 40 years ago. Although conventional CABG is considered both safe and effective, the use of CBP.

A Clinical Evaluation of Terumo’s Prescriptive Oxygenation™ Series Capiox® FX15 and FX25 Hollow Fiber oxygenators with Integrated Arterial Filter in the.

Brad Beckham T4. Definitions  Major blood loss Hemoglobin concentration below 6-10 g/dl  Massive transfusion in adults >9 erythrocyte units within 24h.

Massive transfusion: New Protocol

Coagulation, Fluid, and Blood Management for Cardiac Surgery Maureane Hoffman, MD, PhD Professor of Pathology, Duke University and Director, Transfusion.

Intra operative blood conservation

Vigneshwar Kasirajan, M.D. Division of Cardiothoracic Surgery Vigneshwar Kasirajan, M.D. Division of Cardiothoracic Surgery.

Basic Clinician Training Module 5

MANAGEMENT OF CARDIAC SURGICAL PATIENTS RECEIVING PLATELET INHIBITORS

BLOOD BANKING 1- BLOOD PRODUCTS 2- AUTOLOGOUS TRANSFUSION M. H. Shaheen Maadi Armed Forces Hospital.

Cristy M. Thomas FNP-BC University of Nevada School of Medicine University Medical Center, Las Vegas NV Nevada’s Only Level 1 Adult Trauma, Level 2 Pediatric.

T: Dr Lelanie Pretorius MBChB, MMed (Haemat), PG Dip (Transfusion Medicine) Dept of Haematology and Cell Biology.

Frank W.G. Leebeek, MD PhD Dept of Hematology Erasmus MC Rotterdam, The Netherlands 5 juli 2012 Indicaties voor recombinant factor VIIa (Novoseven) Regionaal.

A bleeding diathesis has been recognized in pt. with CCHD, a variety of coagulation abnormalities has been postulated: 1- Polycythemia 2- Hyper viscosity.

5 Years Results of Off-Pump VS On-Pump CABG 5 Years Results of Off-Pump VS On-Pump CABG Prospective Non-randomized Comparative Study Piya Cherntanomwong*,

Hypercoagulable States Basic Clinician Training Module 4 Introduction Hypercoagulable States Test Your Knowledge.

BY :DR. ISRAA OMAR.  It is initiated concomitantly with coagulation cascade, resulting in the formation of active plasmin,which digest fibrin.  The.

Aprotinin Brian Minarcik, DO January 24, Goals Aprotinin Pharmacology Mangano study Costs and profits Lysine analogs Future of Aprotinin.

Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery Emmanouil I. Kapetanakis, MD; Diego A. Medlam, MD; Kathleen R. Petro, MD; Elizabeth Haile,

Thrombolytic drugs BY :DR. ISRAA OMAR.

Coagulation Considerations for Children undergoing Cardiac Surgery By Marwa A. Khairy, MD.

Gregg W. Stone, Tim Clayton, Roxana Mehran, Efthymios N. Deliargyris, Jayne Prats, Stuart J. Pocock TCT 2012; JACC 2012;60(17SupplB):B16 The HORIZONS-AMI.

G. Rainey Williams Symposium September 30, 2005 CABG in the Elderly Patient: On or Off pump? A Single Center Experience R. Nathan Grantham, M.D.

Developed by: Dawn Johnson, RN, MSN, Ed.  Internally and externally  Prevent bleeding from wounds which could lead to shock or even death.

Module 8: Alternative strategies to transfusion Transfusion Training Workshop KKM 2012.

The Clotting Cascade and DIC Karim Rafaat, MD. Coagulation Coagulation is a host defense system that maintains the integrity of the high pressure closed.

Gregg W. Stone, Tim Clayton, Roxana Mehran, Efthymios N. Deliargyris, Jayne Prats, Stuart J. Pocock Bivalirudin Reduces Cardiac Mortality in Patients with.

1 Combined CRD and DSaRM Advisory Committee Meeting Trasylol (aprotinin) NDA Overview George Shashaty, M.D. Division of Medical Imaging and Hematology.

Fibrinolysis and Hyperfibrinolysis TEG Analysis

Sorin HeartLink – Perfusion Systems and Solutions Christian Chlela Senior Clinical Expert Sorin Group.

DIC. acute, subacute or chronic widespread intravascular fibrin formation in response to excessive blood protease activity that overcomes the natural.

Postoperative Challenges in Neurocritical Care SNACC and NCS Joint Presentation Andrea Orfanakis, MD Oregon Health and Science University Multi-Level Spinal.

ICU Management of the bleeding surgical patient

Management Control or elimination of the underlying cause Severe DIC: – Control of hemodynamic parameters – Respiratory support – Surgery Attempts to treat.

Systemic anticoagulation during ECMO is intended to control thrombin generation and limit the risk for thrombotic and hemorrhagic complications.

Patient Blood Management: Acute Normovolemic Hemodilution

Blood Loss in Total Knee Arthroplasty (control & management)

Fractionated Blood Products in Cardiac Surgery:

Shengshou Hu M.D. National Center for Cardiovascular Disease，China

Damian Gimpel Waikato Cardiothoracic Unit Journal Club

Activation of the Hemostatic System During Cardiopulmonary Bypass

Activation of the Hemostatic System During Cardiopulmonary Bypass

Surgical ICU, Heart Institute University of São Paulo

Lako S, Daka A, Nurka T, Dedej T, Memishaj S

Audit of Blood Product Use in Paediatric Cardiac Bypass Surgery.

Baseline Characteristics of Women and Men in Whom Coronary Heart Disease Developed during Follow-up and Matched Controls - A Jennifer K. Pai et al. N.

Safety and efficacy of off-label use of recombinant factor VIIa in the treatment of life threatening haemorrhage during and after surgery. Qureshi H1,

Benefits of autotransfusion

Know Your ABCs: Antiplatelet Therapy, Benefits/Bleeding, and Cardiac Surgery State of the Art: The Role of Antiplatelet Therapy in the Cardiac Surgical.

Glenn N. Levine et al. JACC 2016;68:

Perioperative management of the bleeding patient

Aprotinin Emily Sarver 11/20/2018.

Warfarin therapy does not increase bleeding in patients undergoing heart transplantation Cullen D Morris, MD, J.David Vega, MD, Jerrold H Levy, MD, Nancy.

George J. Despotis, MD, Michael S. Avidan, MD, Charles W. Hogue, MD

Mean eGFR among survivors after CABG surgery vs all-cause deaths

Preston Woodburn-Camp

Thromboelastography in Trauma

Prospective observational study of the effect of dual antiplatelet therapy with tranexamic acid treatment on platelet function and bleeding after cardiac.

Probability of No Urgent Repeated Percutaneous Revascularization Procedures in the Three Treatment Groups (Kaplan-Meier Plots) Figure 1. Probability of.

LiQian Chen, MD, PhD, Arthur W

% Heparin + GPI IIb/IIIa Bivalirudin +

Aprotinin and Dipyridamole for the Safe Reduction of Postoperative Blood Loss Gideon Cohen, Joan Ivanov, Richard D Weisel, Vivek Rao, Molly K Mohabeer,

Long-Term Survival of Patients With Ischemic Cardiomyopathy Treated by Coronary Artery Bypass Grafting Versus Medical Therapy Eric J. Velazquez, MD,

Implications of Preoperative Thienopyridine Use

A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned Robert E.

Effect of blood transfusion on long-term survival after cardiac operation Milo C Engoren, MD, Robert H Habib, PhD, Anoar Zacharias, MD, Thomas A Schwann,

Transfusion outcomes in patients undergoing coronary artery bypass grafting treated with prasugrel or clopidogrel: TRITON-TIMI 38 retrospective data analysis

Total Arterial Off-Pump Coronary Surgery: Time to Change Our Habits?

Kaplan-Meier estimate of mortality in the two treatment strategies with significant difference between the two groups (log-rank test

Presentation transcript:

Transfusion in Cardiopulmonary Bypass

Blood Use & Cardiac Surgery 1971 – average 8 units RBC per case Late 1980’s – Texas Heart Institute 1.4 units per case, 35% no blood, 31% one unit Jehovah’s Witness series (N=36) - no blood given, blood loss cc, hgb post op, to hgb 9.2 at lowest point post op day 6

Why Reduced Blood Use? Priming pump with electrolyte solution instead of whole blood or PRBC Improved surgical technique Better anesthesia, control of BP Use of inhibitors of fibrinolysis* Re-transfusion of shed blood/cellsaver Tolerance of lower intra-, post-op hgb Hemodilution, autologous donation

Why do CABG patients bleed so much? Aspirin, plavix (clopidogrel) Heparin Exposure of blood to non-endothelialized surfaces Shear forces in pump HemodilutionHypothermia Systemic inflammatory response

What is Excess Bleeding? Bleeding usually occurs after coming off pump Surgical vs Microvascular CT output > cc/hr 2-5% re-operation rate

Edmunds L. N Engl J Med 2004;351: Initial Interactions between Plasma Proteins and Biomaterials

Diagnostic Tools PT/PTT, platelet count, fibrinogen –Often not well correlated with bleeding –TAT to slow to make decisions in OR Activated Clotting Time (ACT) –Used to titrate heparin, no diagnostic value Thromboelastography –Tricky to interpret and run –Info re fibrinolysis

Therapy for Microvascular Bleeding Blood Products –Platelets to treat dysfunction/pump defect –Platelets for count < K –FFP, CRYO, fibrin glue products –RBC hgb < ~8

Antifibrinolytics Aprotinin –Plasmin inhibitor, broader serine protease inhibitor Tranexamic acid, aminocaproic acid –Lysine analog

Recombinant FVIIa Safety & efficacy under review Exclude surgical cause, heparin Correct deficits in platelets and coagulation factors Persistent, excessive bleeding

Schneeweiss S et al. N Engl J Med 2008;358: Relative Risk of In-Hospital Death in the Aprotinin Group as Compared with the Aminocaproic Acid Group, Based on Multivariate Analyses of the 78,199 Patients in the Primary Study Cohort, According to the Amount of Aprotinin

Schneeweiss S et al. N Engl J Med 2008;358: Relative Risk of In-Hospital Death among the 78,199 Patients Undergoing Coronary- Artery Bypass Grafting (CABG) in the Primary Study Cohort

Koch C et al. N Engl J Med 2008;358: Kaplan-Meier Estimates of Survival and Death

Koch C et al. N Engl J Med 2008;358: Postoperative Complications, According to the Duration of Blood Storage