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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Victor A. Ferraris Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ferraris, V. A. Search for Related Content PubMed Articles by Ferraris, V. A. Related Collections Extracorporeal circulation Related Article

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Correspondence

Reply

Division of Cardiovascular & Thoracic Surgery, University of Kentucky Chandler Medical Center, CTW Building, Suite 320, 900 S Limestone, Lexington, KY 40536-0200

(Email: ferraris{at}earthlink.net).

To the Editor:

There are parts of the letter from Baker and colleagues [1] with which I strongly agree and others with which I strongly disagree. First, the agreeable part: I could not be more convinced that perfusionists are a key and essential part of the cardiovascular surgical team. I know that the coauthors of the blood conservation guidelines feel the same.

I strongly disagree with the implication that perfusionists were not involved in the guideline creation process. I personally presented preliminary findings of the guidelines to two national perfusion organizations—American Society of Extra-Corporeal Technology and the American Academy of Cardiovascular Perfusion—and actively sought input from the members of these organizations before creating the final document. Indeed, a preliminary discussion of the guidelines development process appeared in one of the perfusion journals [2].

In similar formal presentations, various state perfusion organizations (including those from Tennessee and Florida) had the same opportunity to see the preliminary blood conservation guideline findings and to comment on these findings before the guidelines underwent the peer review process. In fact, one of the authors of the letter to the editor is a member of the Tennessee state perfusion society and had the opportunity to hear about the guidelines before publication.

The final guideline document contains thoughtful suggestions and comments provided by various members of these organizations. Not only was there no intention to exclude the community of perfusionists from the guideline development process, but, quite the opposite, there was a deliberate intention to include perfusionists in the process.

One of the side effects of practice guideline development is the exposition of areas where information deficits exist. This is especially important, because practice guideline development is only as good as the information available in the published literature. Regarding the issue of ultrafiltration, I stand by the conclusions reached in the guidelines; namely, there is almost no evidence that ultrafiltration limits bleeding or blood transfusion in adults having cardiac procedures using cardiopulmonary bypass. It may be that more information would prove otherwise, but based on available evidence, it is unlikely that ultrafiltration would have a significant benefit in a multimodality blood conservation program. There is a suggestion that this technique may be beneficial in pediatric patients or in those adults with preexisting volume overload. I would point out that 15 of 17 of the guideline authors agree with these recommendations (see Appendix 2 of reference 2) [3].

It is clear that practice guideline development is a dynamic process. New information becomes available that alters guideline recommendations. I am sure that the Society of Thoracic Surgeons Evidence Based Workforce will continue to update and monitor practice guidelines, enlisting all members of the health care delivery team in doing so.

	References

Top References

 

1. Baker RA, Dickinson TA, Shann KG, Likosky DS, Spiwak AB. Perfusion: part of the perioperative blood transfusion and blood conservation management team(letter) Ann Thorac Surg 2008;85:359.[Free Full Text]
2. Ferraris VA, Ferraris S, Saha SP, et al. Evidence-based surgery and patient protocols—guidelines not laws Proc Am Acad Cardiovasc Perf 2007;27:21-41.
3. Society of Thoracic Surgeons Blood Conservation Guideline Task ForceFerraris VA, Ferraris SP, Saha SP, et al. Society of Cardiovascular Anesthesiologists Special Task Force on Blood TransfusionSpiess BD, Shore-Lesserson L, Stafford-Smith M, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline Ann Thorac Surg 2007;83(5 suppl):S27-S86.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Victor A. Ferraris Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ferraris, V. A. Search for Related Content PubMed Articles by Ferraris, V. A. Related Collections Extracorporeal circulation Related Article