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Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Raphael, Jacob MD*; Mazer, C. David MD; Subramani, Sudhakar MD; Schroeder, Andrew MD§; Abdalla, Mohamed MD; Ferreira, Renata MD; Roman, Philip E. MD#; Patel, Nichlesh MD**; Welsby, Ian MBBS††; Greilich, Philip E. MD‡‡; Harvey, Reed MD§§; Ranucci, Marco MD‖‖; Heller, Lori B. MD¶¶; Boer, Christa MD##; Wilkey, Andrew MD***; Hill, Steven E. MD‡‡; Nuttall, Gregory A. MD†††; Palvadi, Raja R. MD‡‡‡; Patel, Prakash A. MD§§§; Wilkey, Barbara MD‖‖‖; Gaitan, Brantley MD¶¶¶; Hill, Shanna S. MD###; Kwak, Jenny MD****; Klick, John MD††††; Bollen, Bruce A. MD‡‡‡‡; Shore-Lesserson, Linda MD§§§§; Abernathy, James MD‖‖‖‖; Schwann, Nanette MD¶¶¶¶,####; Lau, W. Travis MD*****

doi: 10.1213/ANE.0000000000004355
Hemostasis and Thrombosis
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Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point-of-care (POC) coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, have increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has only modestly declined over the last decade, remaining at ≥50% in high-risk patients. Given these limitations, and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists (SCA) has formed the Blood Conservation in Cardiac Surgery Working Group to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

From the *University of Virginia Health System, Charlottesville, Virginia

St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

University of Iowa, Iowa City, Iowa

§University of Wisconsin Medical Center, Madison, Wisconsin

Cleveland Clinic, Cleveland, Ohio

University of Washington Medical Center, Seattle, Washington

#Centura St Anthony Hospital, Lakewood, Colorado

**University of California San Francisco, San Francisco, California

††Duke University Hospital, Durham, North Carolina

‡‡UT Southwestern Medical Center, Dallas, Texas

§§UCLA Medical Center, Los Angeles, California

‖‖IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

¶¶Swedish Medical Center, Seattle, Washington

##VU University Medical Center, Amsterdam, the Netherlands

***Abbott Northwestern Hospital, Minneapolis, Minnesota

†††Mayo Clinic, Rochester, Minnesota

‡‡‡Baylor College of Medicine, Houston, Texas

§§§University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

‖‖‖University of Colorado, Denver, Colorado

¶¶¶Mayo Clinic, Phoenix, Arizona

###Weill Cornell Medical Center, New York, New York

****Loyola University Medical Center, Maywood, Illinois

††††Case Western University Medical Center, Cleveland, Ohio

‡‡‡‡Missoula Anesthesiology, Missoula, Montana

§§§§Zucker School of Medicine at Hofstra/Northwell, Northshore University Hospital, Manhasset, New York

‖‖‖‖Johns Hopkins Medical Center, Baltimore, Maryland

¶¶¶¶Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Tampa, Florida

####AAA Anesthesia Associates, PhyMed Healthcare Group, Allentown, Pennsylvania

*****Pacific Anesthesia, Honolulu, Hawaii.

Published ahead of print 6 May 2019.

Accepted for publication June 5, 2019.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Jacob Raphael, MD, Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22908. Address e-mail to jr5ef@virginia.edu.

Copyright © 2019 International Anesthesia Research Society and Elsevier Inc. All rights reserved.
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