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Patient Blood Management: Recommendations From The 2018 Frankfurt Consensus Conference

M. Müller, H. Van Remoortel, P. Meybohm, K. Aranko, C. Aubron, R. Burger, J. Carson, K. Cichutek, E. De Buck, D. Devine, D. Fergusson, G. Folléa, C. French, Kathrine P. Frey, R. Gammon, J. Levy, M. Murphy, Y. Ozier, K. Pavenski, C. So-Osman, P. Tiberghien, J. Volmink, J. Waters, E. Wood, E. Seifried
Published 2019 · Medicine

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Importance Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
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10.1111/aas.13437
Lower vs higher transfusion threshold in septic shock patients of different ages: A study protocol
A. Jonsson (2019)
10.1111/vox.12919
Reducing the red blood cell transfusion threshold from 8·0 g/dl to 7·0 g/dl in acute myeloid leukaemia patients undergoing induction chemotherapy reduces transfusion rates without adversely affecting patient outcome.
Olivier Ballo (2020)
10.1053/J.JVCA.2019.04.003
Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.
J. Raphael (2019)
10.1001/jamasurg.2019.6024
Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2).
J. Ripollés-Melchor (2020)
10.1053/J.JVCA.2019.06.047
Perioperative Anemia Management as Part of PBM in Cardiac Surgery - A Narrative Updated Review.
P. Meybohm (2019)
10.1111/vox.12852
The systematic use of evidence‐based methodologies and technologies enhances shared decision‐making in the 2018 International Consensus Conference on Patient Blood Management
Hans Van Remoortel (2019)
10.1007/s00134-019-05884-8
Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine
A. Vlaar (2020)
Sepsis to Septic Shock
Seth Whitlow (2017)
10.1182/blood-2019-04-901140
Red blood cells: beyond the transfusion.
B. Shaz (2019)
10.12809/hkmj208397
Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management.
Y. Chow (2020)
10.1136/bmjoq-2019-000776
Improving preoperative haemoglobin using a quality improvement approach to treat iron deficiency anaemia
Rhona C. F. Sinclair (2020)
10.1111/trf.15464
The pillars of patient blood management: key to successful implementation (Article, p. 2840).
Harold C Sullivan (2019)
10.1007/s00068-020-01399-w
Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
A. Franke (2020)
10.1016/j.tracli.2019.08.002
Adverse transfusion reactions in transfused children.
P. Moncharmont (2019)
10.1001/jama.2019.0553
Safeguarding the Patient's Own Blood Supply.
M. Zeller (2019)
10.1186/s13054-019-2543-1
Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials
Yohei Hirano (2019)
10.1093/ajcp/aqaa042
Cryoprecipitate Utilization Patterns Observed With a Required Prospective Approval Process vs Electronic Dosing Guidance.
Robert L. Kruse (2020)
10.1097/aln.0000000000003198
Patient Blood Management: Effectiveness and Future Potential.
D. Spahn (2020)
10.1007/s12630-020-01763-9
When to transfuse your acute care patient? A narrative review of the risk of anemia and red blood cell transfusion based on clinical trial outcomes
G. Hare (2020)
10.1111/voxs.12512
Update on patient blood management 2019
Katerina Pavenski (2020)
10.1055/s-0039-1697933
Perioperative Anemia Management.
Sandaruwani Abeysiri (2019)
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