Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (3): 246-260.doi: 10.24920/004035
• All for People’s Health——Our Decade:Special Reports • Previous Articles Next Articles
Yuntai Yao1, *(), Xin Yuan2, Lixian He1, Yiping Yu1, Yu Du3, Gang Liu4, Lijuan Tian1, Zuxuan Ma5, Yongbao Zhang6, Jie Ma7
Received:
2021-11-01
Accepted:
2022-01-06
Published:
2022-09-30
Online:
2022-01-26
Contact:
Yuntai Yao
E-mail:yuntaiyao@126.com
There is a great burden on the blood supply in China. Over the past decade, Fuwai Hospital has established a multidisciplinary strategy in patient blood management (PBM) which has been demonstrated effective in decreasing transfusion rates and blood consumption, and also contributes to shortening the length of in-hospital stay and lowering the in-hospital mortalities. This paper introduces the strategy of PBM, highlights the evidence and practice of patient blood management at Fuwai Hospital. |
Yuntai Yao, Xin Yuan, Lixian He, Yiping Yu, Yu Du, Gang Liu, Lijuan Tian, Zuxuan Ma, Yongbao Zhang, Jie Ma. Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital[J].Chinese Medical Sciences Journal, 2022, 37(3): 246-260.
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Table 1.
Patient blood management at Fuwai Hospital"
1. | Establishment of a THREE-level administration model. Level ONE: Blood Transfusion Administration Committee of Fuwai Hospital with the hospital president as the director. Level TWO: Department of Medical Affairs. Level THREE: Department of Blood Transfusion. |
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2. | Organization of a multiple-disciplinary patient blood management team. Designation of a coordinator responsible for the affairs related to blood transfusion. |
3. | Enactment and revision of the Blood Transfusion Management Protocols of Fuwai Hospital, which include not only the indications of peri-operative blood transfusion (See below in Item 6) in cardiovascular surgical patients, but also the respective responsibility of surgeons, anesthesiologists, perfusionists and intensivists and detailed guidance for them. The roles of Department of Medical Affairs and Department of Blood Transfusion in blood transfusion management are also clearly defined. |
4. | Adoption of a Blood Consumption Announcement and Scoring System, which regularly publishes notifications of blood volume consumption per surgical case, blood volume consumption per single disease and blood volume consumption per surgeon. The blood volume consumption per surgeon when treating a single disease, has also been incorporated as a criterion to determine the monthly bonus and performance excellency of all surgical wards. |
5. | To guarantee the effectiveness of these strategies, regular inspection and evaluation of the implementation and amendments are made when necessary. |
6. | Transfusion threshold/triggers RBC transfusion is indicated when: ①Hb concentration < 70 g/L during CPB ②Hb concentration < 80 g/L (post-hemofiltration) after weaning from CPB ③Hb concentration < 80 g/L after transfusion of salvaged and/or pump blood ④Hb concentration < 80 g/L in patients undergoing off-pump cardiovascular surgeries ⑤Hb concentration < 90 g/L in aged patients ⑥Hb concentration < 90 g/L in aortic surgical patients FFP transfusion is indicated when: ①Diffuse bleeding with PT >1.5-fold of normal value, APTT > 2.0-fold of normal value ②Massive blood transfusion with transfused volume ≥ estimated total blood volume (70 ml/kg body weight) ③Transfused volume of salvaged blood >2,000 ml ④Inherited or acquired coagulopathies ⑤Coagulation factors deficiency evidenced by TEG ⑥Immediate reversal of warfarin effect ⑦Antithrombin Ⅲ deficiency (“heparin resistance”) ⑧Vitamin K deficiency PC transfusion is indicated when: ①Platelet count < 50 × 109/L ②Re-do cardiovascular surgeries, aortic surgeries, heart transplantation ③Lengthy CPB (duration > 6 h) ④Massive transfusion of allogeneic blood ⑤Platelet dysfunction indicated by TEG |
Table 2.
Intraoperative heparinization scheme at Fuwai Hospital"
Items | Initial heparin dose (U/kg) | Target ACT (s) | Target APTT (s) |
---|---|---|---|
On-pump CVS | 400 | ≥ 410 | - |
OPCAB | 200 | ≥ 300 | - |
Hybrid coronary revascularization | 100-120 for OPCAB, 100 for PCI | ≥ 300 for OPCAB, ≥ 200 for PCI | - |
TAVR | 100 | 250-350 | - |
TTE/TEE-guided transcatheter procedures | |||
PDA occlusion | 0 | - | - |
PFO/ASD/VSD closure | 80―100 | > 250 | - |
LAA occlusion | 80―100 | > 250 | - |
Balloon MV/PV/AV valvuloplasty | 80―100 | > 250 | - |
TEVAR | 80―100 | > 250 | - |
CEA | 100 | > 250 | - |
Peripheral artery stenting | 80―100 | > 250 | - |
Artificial support | |||
IABP | 50―100 | 150―180 | 60―80 |
ECMO | 50―100 | 120―180 | 60―80 |
CRRT | 50―100 | 120―140 | 60―80 |
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