Geissler Raoul Georg, Rotering Heinrich, Buddendick Hubert, Franz Dominik, Bunzemeier Holger, Roeder Norbert, Kwiecien Robert, Sibrowski Walter, Scheld Hans H, Martens Sven, Schlenke Peter
Institute for Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany.
Department of Thoracic and Cardiovascular Surgery, University Hospital of Münster, Münster, Germany.
Transfus Med Hemother. 2015 Mar;42(2):75-82. doi: 10.1159/000377691. Epub 2015 Mar 20.
More blood components are required in cardiac surgery than in most other medical disciplines. The overall blood demand may increase as a function of the total number of cardiothoracic and vascular surgical interventions and their level of complexity, and also when considering the demographic ageing. Awareness has grown with respect to adverse events, such as transfusion-related immunomodulation by allogeneic blood supply, which can contribute to morbidity and mortality. Therefore, programmes of patient blood management (PBM) have been implemented to avoid unnecessary blood transfusions and to standardise the indication of blood transfusions more strictly with aim to improve patients' overall outcomes.
A comprehensive retrospective analysis of the utilisation of blood components in the Department of Cardiac Surgery at the University Hospital of Münster (UKM) was performed over a 4-year period. Based on a medical reporting system of all medical disciplines, which was established as part of a PBM initiative, all transfused patients in cardiac surgery and their blood components were identified in a diagnosis- and medical procedure-related system, which allows the precise allocation of blood consumption to interventional procedures in cardiac surgery, such as coronary or valve surgery.
This retrospective single centre study included all in-patients in cardiac surgery at the UKM from 2009 to 2012, corresponding to a total of 1,405-1,644 cases per year. A blood supply was provided for 55.6-61.9% of the cardiac surgery patients, whereas approximately 9% of all in-patients at the UKM required blood transfusions. Most of the blood units were applied during cardiac valve surgery and during coronary surgery. Further surgical activities with considerable use of blood components included thoracic surgery, aortic surgery, heart transplantations and the use of artificial hearts. Under the measures of PBM in 2012 a noticeable decrease in the number of transfused cases was observed compared to the period from 2009 to 2011 before implementation of the PBM initiative (red blood cells p < 0.002; fresh frozen plasma p < 0.0006; platelets p < 0.00006).
Until now, cardiac surgery comes along with a significant blood supply. By using a case-related data evaluation programme, the consumption of each blood component can be linked to clinical performance groups and, if necessary, to individual patients. Based on the results obtained from this retrospective analysis, prospective studies are underway to begin conducting target / actual performance comparisons to better understand the individual decision-making by the attending physicians with respect to transfusions.
与大多数其他医学学科相比，心脏手术需要更多的血液成分。随着心胸和血管外科手术干预的总数及其复杂程度的增加，以及考虑到人口老龄化，总体血液需求可能会上升。人们对不良事件的认识有所提高，例如异体血液供应引起的输血相关免疫调节，这可能导致发病率和死亡率上升。因此，已实施患者血液管理（PBM）计划，以避免不必要的输血，并更严格地规范输血指征，旨在改善患者的总体预后。
对明斯特大学医院（UKM）心脏外科4年内血液成分的使用情况进行了全面的回顾性分析。基于作为PBM倡议一部分建立的所有医学学科的医疗报告系统，在一个与诊断和医疗程序相关的系统中识别心脏手术中所有接受输血的患者及其血液成分，该系统允许将血液消耗精确分配到心脏手术中的介入程序，如冠状动脉或瓣膜手术。
这项回顾性单中心研究纳入了2009年至2012年UKM心脏外科的所有住院患者，每年共计1405 - 1644例。55.6% - 61.9%的心脏手术患者接受了血液供应，而UKM所有住院患者中约9%需要输血。大多数血液单位用于心脏瓣膜手术和冠状动脉手术期间。大量使用血液成分的其他外科手术包括胸外科手术、主动脉手术、心脏移植和人工心脏的使用。在2012年的PBM措施下，与2009年至2011年PBM倡议实施前的时期相比，观察到输血病例数显著减少（红细胞p < 0.002；新鲜冰冻血浆p < 0.0006；血小板p < 0.00006）。
到目前为止，心脏手术伴随着大量的血液供应。通过使用与病例相关的数据评估程序，每种血液成分的消耗可以与临床绩效组相关联，必要时还可与个体患者相关联。基于这项回顾性分析获得的结果，正在进行前瞻性研究，以开始进行目标/实际绩效比较，以便更好地了解主治医生在输血方面的个体决策。
