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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Abstract

Severe bleeding remains a significant cause of morbidity and mortality in cardiac surgery, and hemostatic blood components, mainly platelet concentrates and fresh frozen plasma, are essential to perioperative hemostatic management. While restrictive strategies for packed red blood cell transfusions are now well established within Patient Blood Management, inappropriate prophylactic transfusions of these hemostatic therapies continue to receive less attention.

This narrative review investigates variations in hemostatic therapy among centres for adult cardiac surgery, and examines the factors that might explain these differences. A review of fourteen original studies involving nearly 220,000 patients from over 1,000 centres worldwide revealed significant variations in platelet and fresh-frozen plasma transfusion rates across centres.

Differences in patient and procedural characteristics cannot entirely explain these variations. Although viscoelastic hemostatic tests have improved bedside assessment and lowered exposure in some settings, they have not eradicated significant variations in practice. The available evidence indicates that hospital culture, local organization, transfusion thresholds, and human factors all have an impact on transfusion behaviour.

Optimizing the use of hemostatic therapies in adult cardiac surgery will therefore not only require better tools and protocols, but also increased focus on the organizational and non-technical factors that influence decision-making.

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Authors

Alexandre Sebestyen Department of Cardiac Surgery, Grenoble Alpes University Hospital, Grenoble, France; Alps Research Assessment and Simulation Centre (CESAR), TIMC Laboratory, Grenoble Alpes University, Grenoble, France ORCID

Julien Picard Department of Anesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France; Alps Research Assessment and Simulation Centre (CESAR), TIMC Laboratory, Grenoble Alpes University, Grenoble, France ORCID

Jean-Noël Evain Department of Anesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France ORCID

Alexandre Behouche Department of Cardiac Surgery, Grenoble Alpes University Hospital, Grenoble, France ORCID

Olivier Chavanon University Hospital Grenoble-Alpes ORCID

Pierre Albaladejo Department of Anesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France; Alps Research Assessment and Simulation Centre (CESAR), TIMC Laboratory, Grenoble Alpes University, Grenoble, France

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