ERAS Cardiac society turnkey order set for patient blood management: Proceedings from the AATS ERAS Conclave 2023.

There are multiple published guidelines on comprehensive patient blood management (PBM), centered on the 3 pillars of PBM: managing preoperative anemia, minimizing blood loss, and tolerating intraoperative/postoperative anemia. The intention of this endeavor, therefore, was to undertake We sought to create an order set to facilitate widespread implementation of evidence-based PBM for cardiac surgery patients. Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for PBM. Orders derived from consistent class I, class IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently class I or IIA, class IIB, or supported by published evidence are presented in italic type. Preoperatively, there are strong recommendations to screen and treat preoperative anemia with iron replacement and erythropoietin and to discontinue dual antiplatelet therapy if the patient can safely wait for surgery. Intraoperative orders outline the routine use of an antifibrinolytic agent, cell saver, point of care viscoelastic testing, and use of a standard transfusion algorithm. The order set also reflects strong recommendations intraoperatively and postoperatively for agreed-upon hemoglobin thresholds to consider transfusion of packed red blood cells. A hemoglobin threshold should be adopted according to local team consensus and should trigger a discussion regarding transfusion. The benefit of a multidisciplinary PBM care pathway in cardiac surgery has been well established, yet implementation remains variable. Using recommendations from existing guidelines, we have created a TKO to facilitate the implementation of PBM.

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Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest Statement D.T.E. reports serving on a device safety monitoring board for Edwards Lifesciences Medical and on advisory boards for Astellas Pharma, Alexion, Terumo, Medela, and Renibus Therapeutics. R.C.A. reports honoraria from Edwards Lifesciences and HLS Therapeutics and serving on an advisory board for Renibus Therapeutics. R.S. discloses consulting/advisory relationships with Zimmer Biomet, Atricure, La Jolla, Terumo, Encare, and Edwards Lifesciences. S.H. discloses a consultant relationship with Encare. J.R. reports research support from and advisory board work for Octapharma, and serving on the Executive Board for the CRPTICS Trial (NCT 04709705). K.W.L. reports consulting for Abiomed, Alexion, Medela, Medtronic, and Renibus. S.C. has served on Advisory Boards for Edwards Lifesciences, La Jolla Pharmaceuticals, Baxter Pharmaceuticals, and Eagle Pharmaceuticals. A.J.G. reports speaker and advisory activities for Edwards Lifesciences. V.M-B. reports serving on a speakers bureau for Edwards Lifesciences. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.