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Ali AA, Hamwi T, Sikman L, Stana J, Abicht JM, Tsilimparis N, Prendes CF. The Importance of Cell Saver Usage in Complex Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms. Ann Vasc Surg 2024; 109:297-308. [PMID: 39029896 DOI: 10.1016/j.avsg.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The use of the cell saver is well-established in open aneurysm repair; however, its role in endovascular repair is yet to be determined. The aim of this study was to analyze the effects of cell saver usage in patients undergoing complex endovascular procedures. MATERIALS AND METHODS Single-center retrospective cohort study, including consecutive patients undergoing fenestrated and/or branched repair for the treatment of thoracoabdominal and complex abdominal aortic aneurysms (CAAAs) between January 2019 and December 2022. The cell saver was a standard part of the intraoperative setup of these procedures, and its use was readily available. The primary endpoint was the percentage of patients, in which autologous blood collected was transfused (cell saver blood transfusion [CSBT]), alongside the useable amount obtained. Secondary endpoints included mean blood loss, postoperative hemoglobin levels, and 30-day mortality. RESULTS A total of 170 patients (77.1% male, mean age 71.2 ± 9.2 years) were included, with a median blood loss of 700 mL (interquartile range [IQR] 400-1,200 mL). A total of 96 patients received some kind of blood transfusion (BT) (56.5%): 35 patients were (20.6%) allogenic BT, 31 patients were (18.2%) CSBT only, and 30 patients were (17.6%) a combination of both. In total, 61 patients (35.9% or 63.5% of all patients requiring BTs) received CSBT, with a median useable blood volume of 282 mL (IQR, 194.5-508 mL). Thirty-day mortality was similar in both groups. Although the CSBT group had lower intraoperative hemoglobin values (9.25 ± 1.55 vs. 10.36 ± 1.88 mg/dL; P < 0.001), both groups presented similar postoperative hemoglobin (Hb) levels. CONCLUSIONS Blood loss during complex endovascular repair is not insignificant. In this cohort, over 50% of included patients required some kind of BT, 32.3% of which received exclusively CSBT, while 31.3% had supplementary CSBT alongside allogenic BT. This data showcases its potential role in these repairs, paving the way for its standardization in the intraoperative setup of these complex procedures.
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Affiliation(s)
- Ahmed A Ali
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany; Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Mansoura University, Mansoura, Egypt
| | - Tarek Hamwi
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Laura Sikman
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jan Stana
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jan-Michael Abicht
- Department of Anesthesiology - University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Carlota F Prendes
- Department of Vascular Surgery - Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
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Ortiz JLC, Griffin I, Kazakova SV, Stewart PB, Kracalik I, Basavaraju SV. Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022. Transfusion 2024; 64:627-637. [PMID: 38476028 PMCID: PMC11299550 DOI: 10.1111/trf.17775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Transfusion-related errors are largely preventable but may lead to blood product wastage and adverse reactions, resulting in patient harm. In the United States, the incidence of transfusion-related errors is poorly understood nationally. We used data from the National Healthcare Safety Network (NHSN) Hemovigilance Module to describe and quantify transfusion-related errors, as well as associated transfusion-related adverse reactions and blood product wastage. METHODS During 2014-2022, data from the NHSN Hemovigilance Module were used to analyze errors, including near misses (errors with no transfusion), incidents (errors with transfusion), and associated serious adverse reactions (severe, life-threatening, or death). RESULTS During 2014-2022, 80 acute care facilities (75 adult; 5 pediatric) reported 63,900 errors. Most errors occurred during patient blood sample collection (21,761, 34.1%) and blood sample handling (16,277, 25.5%). Less than one-fifth of reported errors (9822, 15.4%) had a completed incident form. Of those, 8780 (89.3%) were near misses and 1042 (10.7%) incidents. More than a third of near misses (3363, 38.3%) were associated with a discarded blood product, resulting in 4862 discarded components. Overall, 87 adverse reactions were associated with errors; six (7%) were serious. CONCLUSIONS Over half of the transfusion-related errors reported to the Hemovigilance Module occurred during blood sample collection or sample handling. Some serious adverse reactions identified were associated with errors, suggesting that additional safety interventions may be beneficial. Increased participation in the Hemovigilance Module could enhance generalizability and further inform policy development regarding error prevention.
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Affiliation(s)
- Joel L. Chavez Ortiz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Atlanta, Georgia, USA
| | - Isabel Griffin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sophia V. Kazakova
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phylicia B. Stewart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Corporation, Atlanta, Georgia, USA
| | - Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar V. Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Morse B, Anstett T, Mistry N, Porter S, Pincus S, Lin CT, Novins-Montague S, Ho PM. User-Centered Design to Reduce Inappropriate Blood Transfusion Orders. Appl Clin Inform 2023; 14:28-36. [PMID: 36630999 PMCID: PMC9833954 DOI: 10.1055/s-0042-1759866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To improve blood transfusion practices, we applied user-centered design (UCD) to evaluate potential changes to blood transfusion orders. OBJECTIVES The aim of the study is to build effective transfusion orders with different designs to improve guideline adherence. METHODS We developed three different versions of transfusion orders that varied how information was presented to clinicians ordering blood transfusions. We engaged 14 clinicians (residents, advanced practice providers [APPs], and attending physicians) from different specialties. We used the think aloud technique and rapid qualitative analysis to generate themes to incorporate into our modified orders. RESULTS Most end-users who participated in the semi-structured interviews preferred the interruptive alert design plus behavioral nudges (n = 8/14, 57%). The predominant rationale was that the in-line alert was not visually effective in capturing the end-user's attention, while the interruptive alert forced a brief stop in the workflow to consider the guidelines. All users supported the general improvements, though for different reasons, and as a result, the general improvements remained in the designs for the forthcoming trial. CONCLUSION The user experience uncovered through the think aloud approach produced a clear and rich understanding of potentially confounding factors in the initial design of different intervention versions. Input from end-users guided the creation of all three designs so each was addressing human factors with parity, which ensured that the results of our study reflected differences in interruptive properties of the alerts and not differences in design.
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Affiliation(s)
- Brad Morse
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States,Address for correspondence Brad Morse, PhD, MA Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine1890 N Revere Ct, Aurora, CO 80045United States
| | - Tyler Anstett
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Neelam Mistry
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Samuel Porter
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Sharon Pincus
- Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Chen-Tan Lin
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Sylvie Novins-Montague
- Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - P. Michael Ho
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
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Piette N, Carella M, Beck F, Hans G, Bonhomme V, Lecoq JP. Effectiveness of intraoperative cell salvage in aseptic revision total hip arthroplasty: a single-center retrospective study. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background and study aim: Revision of total hip arthroplasty (rTHA) is associated with significant blood loss. We have used intraoperative cell savage (ICS) systematically in these patients for the last ten years. We sought to determine how often re-suspended red blood cells could be re-transfused and to identify predictors of re- transfusion.
Materials and methods: Patients who underwent aseptic rTHA between January 2011 and December 2020 at our center were enrolled in this retrospective observational study. Exclusion criteria were revision for infection or tumor. The primary outcome was the successful use of ICS defined as the ability to re-transfuse at least 125 mL of ICS blood. Secondary outcome measures included re-transfused ICS blood volume, aspirated blood volume, allogenic blood transfusion, and post-operative hemoglobin level. Uni- and multi-variable logistic regressions were used to identify patients and procedure characteristics associated with successful ICS. Mann-Whitney U tests, Student’s t tests and Chi-square tests were used to compare outcomes between patients with and without successful ICS. A P value < 0.05 was considered statistically significant.
Results: ICS was successful in 93 (69.9%) out of 133 patients. The extent of revision, categorized as isolated acetabulum, isolated femur, or combined revision was the only predictor of successful ICS. Postoperative hemoglobin levels as well as rate and amount of allogenic red blood cells transfusion did not differ between the groups.
Conclusions: ICS is useful in most patients undergoing rTHA. Those requiring a combined revision have the greatest chance of successful re-infusion.
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Schmidbauer SL, Seyfried TF. Cell Salvage at the ICU. J Clin Med 2022; 11:3848. [PMID: 35807132 PMCID: PMC9267827 DOI: 10.3390/jcm11133848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
Patient Blood Management (PBM) is a patient-centered, systemic and evidence-based approach. Its target is to manage and to preserve the patient's own blood. The aim of PBM is to improve patient safety. As indicated by several meta-analyses in a systematic literature search, the cell salvage technique is an efficient method to reduce the demand for allogeneic banked blood. Therefore, cell salvage is an important tool in PBM. Cell salvage is widely used in orthopedic-, trauma-, cardiac-, vascular and transplant surgery. Especially in cases of severe bleeding cell salvage adds significant value for blood supply. In cardiac and orthopedic surgery, the postoperative use for selected patients at the intensive care unit is feasible and can be implemented well in practice. Since the retransfusion of unwashed shed blood should be avoided due to multiple side effects and low quality, cell salvage can be used to reduce postoperative anemia with autologous blood of high quality. Implementing quality management, compliance with hygienic standards as well as training and education of staff, it is a cost-efficient method to reduce allogeneic blood transfusion. The following article will discuss the possibilities, legal aspects, implementation and costs of using cell salvage devices in an intensive care unit.
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Affiliation(s)
- Stephan L. Schmidbauer
- Department of Anesthesiology, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Timo F. Seyfried
- Department of Anesthesiology, Ernst von Bergmann Hospital, 14467 Potsdam, Germany
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