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A multi-strategy approach to controlling inflammatory response

Beyond the Economic Impact of transfusion

According to Timothy Hannon, M.D., President and Founder of the Strategic Healthcare Group, a blood management consulting firm, "In 2008, everyone was talking about [blood management].  In 2009, everyone wants to do it."

Indeed, as the cost of donor blood has risen in recent years and supplies have dwindled, hospitals have been encouraging clinicians to examine their use of donor blood products and adopt blood management programs.  Interest in blood management is widespread and not limited to clinical discussion; the topic has been reported on in such non-clinical publications as the Wall Street Journal.1 

Although the renewed attention to blood management is primarily cost-driven, clinicians have long recognized the clinical benefits associated with minimizing the use of donor blood. Transfusions have been linked to many negative outcomes, including the single biggest cause of morbidity and mortality after cardiac surgery - inflammatory response.2-4

A Multi-Strategy Approach

However, reducing transfusions is but one strategy that can be employed to reduce inflammatory response.  For decades, surgeons, anesthesiologists and perfusionists have studied the interrelated causes and multiple effects of inflammatory response in attempts to minimize the impact of cardiopulmonary bypass. In addition to reducing transfusions, cardiac teams have documented several additional important strategies:

  • Minimizing the blood/foreign surface interface 5
  • Reducing microemboli 6
  • Reducing inflammatory mediators 7,8

Each of these can be addressed, at least partly, through the conduct of cardiopulmonary bypass where the adoption of even a single new technology or technique can create an incremental improvement in the reduction of inflammatory response.

1. Landro, L. Hospitals Seek to Limit Use of Transfusions. Wall Street Journal, October 29, 2010. Web

2. Adams PT, et al. Detection of Circulating Donor White Blood Cells in Patients Receiving Multiple Transfusions. Blood 1992; 80:551-5.

3. Blumberg N, et al. Transfusion-Induced Immunomodulation and its Clinical Consequences. Transfus Med Rev 1990;4:24-35.

4. Muylle L. The Role of Cytokines in Blood Transfusion Reactions. Blood Rev 1995; 9:77-83.

5. El-Essawi A, et al. A Prospective Randomised Multicentre Clinical Comparison Of A Minimised Perfusion Circuit Versus Conventional Cardiopulmonary Bypass. Presented at the 23rd Annual Meeting of the European Society of Cardiothoracic Surgery, October, 2009.

6. Gunaydin S, et al. Clinical Evaluation of Minimized Extracorporeal Circuit in High-Risk Coronary Revascularization: Impact on Air handling, Inflammation, Hemodilution, and Myocardial Function. Perfusion 2009:24; 153.

7. Kutschka I, et al. Beneficial Effects of Modern Perfusion Concepts in Aortic Valve and Aortic Root Surgery. Perfusion 2009:24; 37.

8. Barak M, et al. Microbubbles: Pathophysiology and Clinical Implications. Chest 2005:128; 2918-2932.

9. Edmunds LH Jr. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1998:66; S12-6.

10. Wan S, et al. Inflammatory Response to Cardiopulmonary Bypass: Mechanisms Involved and Possible Therapeutic Strategies. Chest 1997:112(3); 676-92.

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Key Strategies Perfusionists Can Employ to Reduce Inflammatory Response

  • Reduce transfusions
  • Minimize the blood/foreign surface interface
  • Reduce microemboli
  • Reduce inflammatory mediators