Approximately 20-40% of cardiac surgery patients have pre-operative anemia, and about half are transfused. Randomized controlled trials have shown intravenous iron combined with erythropoietin (EPO) reduces operative RBC transfusions for cardiac surgery patients. Central venous oxygen saturation (ScvO2) levels can help determine whether cardiac output is sufficient to meet tissue demand and thus whether a RBC transfusion is needed when analyzed with hemoglobin concentrations. A research team in France “bundled” all of these approaches together in a pilot trial to determine if RBC transfusions and long-term anemia could be reduced. Briefly, 128 cardiac surgery patients (54% male; mean age, 70 years) were randomized 1:1. Sixty-two patients in the STOP arm were assigned to receive EPO and intravenous iron if hemoglobin levels dropped below 13 g/dL one day before surgery or at ICU admission; patients were transfused RBCs if hemoglobin values were ≤8 g/dL and ScvO2 values were 65% or below; patients in the STOP arm were given an additional dose of EPO if hemoglobin levels fell between 8 and 13 g/dL. The 61 patients in the control arm were transfused based on a restrictive strategy for cardiac surgery patients if hemoglobin was ≤8 g/dL; additionally, control patients received intravenous iron if hemoglobin levels were between 8 and 13 g/dL. Only nine patients (15%; 9/62) in the STOP arm required RBC transfusions compared to 19 in the control arm (31%; 19/61) (p=0.03). Bundling interventions and integrating physiological thresholds may lower RBC transfusions for cardiac surgery patients, but larger studies are needed.
References:
- Saour M, Blin C, Zeroual N, Mourad M, et al. Impact of a bundle of care (intravenous iron, erythropoietin and transfusion metabolic adjustment) on post-operative transfusion incidence in cardiac surgery: a single-centre, randomized, open-label, parallel-group controlled pilot trial. The Lancet Regional Health- Europe 2024; vol 42
- Aubron C. Are we on the verge of a paradigm shift in transfusion decision-making? The Lancet Regional Health-Europe 2024; vol 42
