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Ann Thorac Surg 2011;91:944-982. doi:10.1016/j.athoracsur.2010.11.078
© 2011 The Society of Thoracic Surgeons
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Victor A. Ferraris
George J. Despotis
John W. Hammon
Sibu P. Saha
Howard K. Song
Ellen R. Clough
Linda J. Shore-Lesserson
Robert A. Baker
Timothy A. Dickinson
Donald S. Likosky
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Special Report: STS Workforce on Evidence Based Surgery

2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines*

Victor A. Ferraris, MD, PhD, (Chair), The Society of Thoracic Surgeons Blood Conservation Guideline Task Forcea,*, Jeremiah R. Brown, PhD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forceg, George J. Despotis, MD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forcef, John W. Hammon, MD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forceh, T. Brett Reece, MD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forceo, Sibu P. Saha, MD, MBA, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forcea, Howard K. Song, MD, PhD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forcen, Ellen R. Clough, PhD, The Society of Thoracic Surgeons Blood Conservation Guideline Task Forceq, Linda J. Shore-Lesserson, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusione, Lawrence T. Goodnough, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusiond, C. David Mazer, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusioni, Aryeh Shander, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusionc, Mark Stafford-Smith, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusionp, Jonathan Waters, MD, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusionb, Robert A. Baker, PhD, Dip Perf, CCP (Aus), The International Consortium for Evidence Based Perfusionj, Timothy A. Dickinson, MS, The International Consortium for Evidence Based Perfusionl, Daniel J. FitzGerald, CCP, LP, The International Consortium for Evidence Based Perfusionm, Donald S. Likosky, PhD, The International Consortium for Evidence Based Perfusionk, Kenneth G. Shann, CCP, The International Consortium for Evidence Based Perfusione

a Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky
b Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
c Departments of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
d Departments of Pathology and Medicine, Stanford University School of Medicine, Stanford, California
e Departments of Anesthesiology and Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
f Departments of Anesthesiology, Immunology, and Pathology, Washington University School of Medicine, St. Louis, Missouri
g Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology, Dartmouth Medical School, Lebanon, New Hampshire
h Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
i Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario
j Cardiac Surgical Research Group, Flinders Medical Centre, South Australia, Australia
k Department of Surgery, Medicine, Community and Family Medicine, and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire
l SpecialtyCare, Nashville, Tennessee
m Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
n Division of Cardiothoracic Surgery, Oregon Health and Science University Medical Center, Portland, Oregon
o Department of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Aurora, Colorado
p Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
q The Society of Thoracic Surgeons, Chicago, Illinois

* Address correspondence to Dr Ferraris, Division of Cardiothoracic Surgery, University of Kentucky, A301, Kentucky Clinic, 740 S Limestone, Lexington, KY 40536-0284 (Email: ferraris{at}earthlink.net).

Background: Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007.

Methods: The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical ‘OR’ connector—Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical ‘AND’ connector.

Results: In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management.

Conclusions: Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations.




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