Bloodless Cardiac Surgery in Jehovah's Witness: A Comprehensive Review.


Journal

Cardiology in review
ISSN: 1538-4683
Titre abrégé: Cardiol Rev
Pays: United States
ID NLM: 9304686

Informations de publication

Date de publication:
17 May 2024
Historique:
medline: 17 5 2024
pubmed: 17 5 2024
entrez: 17 5 2024
Statut: aheadofprint

Résumé

This article explores the major challenges and specialized strategies involved in managing cardiovascular surgery patients who are Jehovah's Witnesses and refuse blood transfusions due to their religious beliefs. It delves into preoperative, intraoperative, and postoperative approaches aimed at minimizing blood loss and optimizing patient outcomes while respecting their autonomy. Preoperative measures focus on correcting anemia and coagulopathy through targeted interventions, such as iron supplementation and erythropoietin therapy, and meticulous screening for bleeding disorders. Intraoperative techniques include the use of vasoconstrictors, hemostatic agents, and innovative blood conservation methods like acute normovolemic hemodilution and cell salvage. Postoperative care emphasizes infection control, hemostasis, and judicious monitoring to prevent anemia and facilitate recovery. Through a multidisciplinary approach and adherence to evidence-based practices, healthcare providers can effectively meet the needs of Jehovah's Witness patients, ensuring safe and successful cardiovascular surgery outcomes without the use of blood transfusions.

Identifiants

pubmed: 38757968
doi: 10.1097/CRD.0000000000000725
pii: 00045415-990000000-00268
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure: The authors declare no conflict of interest.

Références

Hartrumpf M, Kuehnel RU, Ostovar R, et al. Everyday cardiac surgery in Jehovah’s Witnesses of typically advanced age: clinical outcome and matched comparison. J Clin Med. 2023;12:5110.
Chae C, Okocha O, Sweitzer B. Preoperative considerations for Jehovah’s Witness patients: a clinical guide. Curr Opin Anaesthesiol. 2020;33:432–440.
Thompson HA. Blood transfusions and Jehovah’s Witnesses. Tex Med. 1989;85:57–59.
History of Bloodless Medicine and Surgery [Medstar Health Website]. April 26, 2019. Available at: https://www.medstarhealth.org/news-and-publications/articles-and-research-reports/history-of-bloodless-medicine-and-surgery. Accessed April 04, 2024.
Okorie CO, Pisters LL. Evolution of bloodless surgery: a case for bloodless suprapubic prostatectomy. Niger Med J. 2019;60:169–174.
The Growing Demand for Bloodless Medicine and Surgery [Watchtower ONLINE LIBRARY]. January 08, 2000. Available at: https://wol.jw.org/en/wol/d/r1/lp-e/102000003. Accessed April 06, 2024.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists task force on perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006;105:198–208.
Sparling EA, Nelson CL, Lavender R, et al. The use of erythropoietin in the management of Jehovah’s Witnesses who have revision total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1548–1552.
Gohel MS, Bulbulia RA, Slim FJ, et al. How to approach major surgery where patients refuse blood transfusion (including Jehovah’s Witnesses). Ann R Coll Surg Engl. 2005;87:3–14.
Bracey A. Bloodless cardiac surgery: a strategy for few or the future standard of care? Transfusion. 2015;55:2773–2774.
Gombitz H, Rehak P, Shander A, et al. The second Austrian benchmark study for blood use in elective surgery: results and practice change. Transfusion. 2014;54:2646–2657.
McCartney S, Guinn N, Roberson R, et al. Jehovah’s Witnesses and cardiac surgery: a single institution’s experience. Transfusion. 2014;54:2745–2752.
Moraca RJ, Wanamaker KM, Bailey SH, et al. Strategies and outcomes of cardiac surgery in Jehovah’s Witnesses. J Card Surg. 2011;26:135–143.
Barczewska M. Naczyniowe operacje wewnatrzczaszkowe u świadków Jehowy. Erytropoetyna w przygotowaniu do operacji [Vascular intracranial procedures in Jehovah’s Witnesses. Erythropoietin in the preparation for the surgery]. Neurol Neurochir Pol. 1997;31:271–280.
Johnson-Arbor K, Verstraete R. Use of hyperbaric oxygenation as an adjunctive treatment for severe pernicious anaemia in a bloodless medicine patient. BMJ Case Rep. 2021;14:e240619.
Renew JR, Joshi GP, Crowley M. Clinical use of neuromuscular blocking agents in anesthesia. 2024.
Tanaka A, Ota T, Uriel N, et al. Cardiovascular surgery in Jehovah’s Witness patients: the role of preoperative optimization. J Thorac Cardiovasc Surg. 2015;150:976–983.
Erdoes G, Faraoni D, Koster A, et al. Perioperative considerations in management of the severely bleeding coagulopathic patient. Anesthesiology. 2023;138:535–560.
Preparing for Bloodless Surgery or Alternatives to Blood Transfusions at Penn. Available at: https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/center-for-transfusion-free-medicine/management-techniques/preparing-for-surgery. Accessed April 10, 2024.
Habler O, Voss B. Perioperatives management bei zeugen jehovas. spezielle berücksichtigung der religiös motivierten ablehnung von fremdblut [Perioperative management of Jehovah’s Witness patients. Special consideration of religiously motivated refusal of allogeneic blood transfusion]. Anaesthesist. 2010;59:297–311.
Trzciński R, Kujawski R, Mik M, et al. Surgery in Jehovah’s Witnesses - our experience. Prz Gastroenterol. 2015;10:33–40.
Henderson AM, Maryniak JK, Simpson JC. Cardiac surgery in Jehovah’s Witnesses. A review of 36 cases. Anaesthesia. 1986;41:748–753.
Nader ND, Khadra WZ, Reich NT, et al. Blood product use in cardiac revascularization: comparison of on- and off-pump techniques. Ann Thorac Surg. 1999;68:1640–1643.
Sniecinski RM, Chen EP, Levy JH, et al. Coagulopathy after cardiopulmonary bypass in Jehovah’s Witness patients: management of two cases using fractionated components and factor VIIa. Anesth Analg. 2007;104:763–765.
Klein AA, Bailey CR, Charlton A, et al. Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah’s Witnesses and patients who refuse blood. Anaesthesia. 2018;74:74–82.
Lindstrom E, Johnstone R. Acute normovolemic hemodilution in a Jehovah’s Witness patient: a case report. AANA J. 2010;78:326–330.
Nagy CJ, Wheeler AS, Archer TL. Acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah’s Witness with placenta percreta. Int J Obstet Anesth. 2008;17:159–163.
Morimoto T, Ichinomiya T, Murata H, et al. Management of combined cardiac surgery using cardiopulmonary bypass with acute normovolemic hemodilution in a Jehovah’s Witness: a case report. Cureus. 2023;15:e33442.
Mladinov D, Eudailey KW, Padilla LA, et al. Effects of acute normovolemic hemodilution on post-cardiopulmonary bypass coagulation tests and allogeneic blood transfusion in thoracic aortic repair surgery: an observational cohort study. J Card Surg. 2021;36:4075–4082.
Mason L, Fitzgerald C, Powell-Tuck J, et al. Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation. Ann R Coll Surg Engl. 2011;93:398–400.
Semkiw LB, Schurman DJ, Goodman SB, et al. Postoperative blood salvage using the cell saver after total joint arthroplasty. J Bone Joint Surg Am. 1989;71:823–827.
Waters JH, Potter PS. Cell Salvage in the Jehovah’s Witness patient. Anesth Analg. 2000;90:229–230.
Caring for Patients Who Refuse Blood [The Royal College of Surgeons of England]. November, 2016. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/patients-who-refuse-blood/. Accessed April 11, 2024.
Putney LJ. Bloodless cardiac surgery. In: Crit Care Nurs Q. Vol. 30. 3rd ed. Lippincott Williams & Wilkins; 2007:263–270.
Ott DA, Cooley DA. Cardiovascular surgery in Jehovah’s Witnesses. Report of 542 operations without blood transfusion. JAMA. 1977;238:1256–1258.
Jassar AS, Ford PA, Haber HL, et al. Cardiac surgery in Jehovah’s Witness patients: ten-year experience. Ann Thorac Surg. 2012;93:19–25.
Nanni G, Vitolo M, Imberti JF, et al. Short and long-term outcomes after cardiac surgery in Jehovah’s Witnesses patients: a case-control study. Intern Emerg Med. 2023;18:151–162.
Vitolo M, Mei DA, Cimato P, et al. Cardiac surgery in Jehovah’s Witnesses patients and association with peri-operative outcomes: a systematic review and meta-analysis. Curr Probl Cardiol. 2023;48:101789.

Auteurs

Darshil Kumar Maheta (DK)

From the School of Health Science and Policy, New York Medical College, Valhalla, NY.

William H Frishman (WH)

Department of Medicine, New York Medical College, Valhalla, NY.

Wilbert S Aronow (WS)

Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.

Classifications MeSH