University of Oulu

Andrew Klein, Seema Agarwal, Bernard Cholley, Jens Fassl, Michael Griffin, Timo Kaakinen, Zineb Mzallassi, Patrick Paulus, Steffen Rex, Martin Siegemund, Annewil van Saet, A survey of patient blood management for patients undergoing cardiac surgery in nine European countries, Journal of Clinical Anesthesia, Volume 72, 2021, 110311, ISSN 0952-8180,

A survey of patient blood management for patients undergoing cardiac surgery in nine European countries

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Author: Klein, Andrew1; Agarwal, Seema2; Cholley, Bernard3,4;
Organizations: 1Consultant, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
2Consultant in Cardiac Anaesthesia and ICU Honorary Senior Lecturer Manchester University Hospitals, Manchester, UK
3AP-HP Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France
4Université de PARIS, INSERM UMR-S 1140, Innovations Thérapeutiques en Hémostase, Faculté de Pharmacie, 4 avenue de l'observatoire, 75006 Paris, France
5Herzzentrum Dresden GmbH Universitätsklinik an der Technischen Universität Dresden, Fetscherstraße 76, 01307 Dresden, Germany
6Mater University Hospital and Mater Private Hospital, Dublin, Associate Professor of Anaesthesiology & Perioperative Medicine, UCD Medical School, Irish Medical Council, Dublin, Ireland
7Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
8Department of Anesthesiology; Erasmus Medical Center, Rotterdam, the Netherlands
9Kepler University Hospital GmbH, Med Campus III, Department of Anesthesiology and Intensive Care Medicine, Krankenhausstrasse 9, 4020 Linz, Austria
10Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
11Intensive Care Unit Department of Clinical Research, University Basel, Switzerland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.1 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2021-06-29


Study objective: To describe and compare patient blood management (PBM) practices in cardiac surgery in nine European countries and identify the main risk factors for bleeding or transfusion according to the surveyed centres.

Design: We set up an online survey to evaluate PBM practices in two clinical scenarios, risk factors for bleeding or transfusion, and previous experience with antifibrinolytics.

Setting: This survey was completed by European anesthesiologists in 2019.

Patients: No patients were included in the survey.

Intervention: None.

Measurements: We evaluated the degree of implementation of PBM practices in patients undergoing cardiac surgery.

Main results: Ninety-eight of 177 responses (38%) were complete with variable response rates by country. In a non-emergent situation, no respondents would transfuse red cells preoperatively in an anaemic patient, while cell salvage (89%) and antifibrinolytics (82%) would almost always be used. Optimization of Hemoglobin level (36%) and use of off-pump techniques (34%), minimally invasive surgery (25%) and relatively recently-developed CPB technologies such as mini-bypass (32%) and autologous priming (38%), varied greatly across countries. In an emergent clinical situation, topical haemostatic agents would frequently be used (61%). Tranexamic acid (72%) and aprotinin (20%) were the main antifibrinolytics used, with method of administration and dose varying markedly across countries. Five factors were considered to increase risk of bleeding or transfusion by at least 90% of respondents: pre-operative anaemia, prior cardiac surgery, clopidogrel 5 days or less before surgery, use of other P2Y12 inhibitors at any point, and thrombocytopenia <100.10⁹ platelets/mm³.

Conclusion: PBM guidelines are not universally implemented in European cardiac surgery centres or countries, resulting in discrepancies in techniques and products used for a given clinical situation.

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Series: Journal of clinical anesthesia
ISSN: 0952-8180
ISSN-E: 1873-4529
ISSN-L: 0952-8180
Volume: 72
Article number: 110311
DOI: 10.1016/j.jclinane.2021.110311
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by Nordic Pharma, which hired Sirius-Customizer (France), a data management consulting company, to assist the authors in the development of the online survey, data management and statistical analyses. Nordic Pharma did not have access to the raw data and did not participate in either the analysis of the data or the writing of the manuscript.
Copyright information: © 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (