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Individualised acute normovolaemic haemodilution for non-cardiac surgery with anticipated high-dose red cell transfusion: study protocol for a randomised controlled trial in West China Hospital of Sichuan University.
BMJ Open
January 2025
Department of Anesthesia and Operation Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Introduction: Acute normovolaemic haemodilution (ANH) is a perioperative blood management technique involving the removal of whole blood and simultaneous infusion of colloids or crystalloids to achieve haemodilution while maintaining normovolaemia. However, its efficacy in reducing the requirement for perioperative allogeneic blood transfusion remains controversial due to inconsistent findings in the literature. An individualised red cell transfusion strategy, guided by the West China Liu's Score, has demonstrated effectiveness in reducing the need for allogeneic red cell transfusion.
View Article and Find Full Text PDFTranscoronary cooling and dilution for cardioprotection during revascularisation for ST-segment elevation myocardial infarction: design and rationale of the STEMI-Cool study.
Am Heart J
December 2024
Department of cardiology, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, London, UK; King's College London, London, UK.
Background: ST-segment elevation myocardial infarction (STEMI) is treated with immediate primary percutaneous coronary intervention (pPCI) to restore coronary blood flow in the acutely ischaemic territory, but is associated with reperfusion injury limiting the benefit of the therapy. No treatment has proven effective in reducing reperfusion injury. Transcoronary hypothermia has been tested in clinical studies and is well tolerated, but is generally established after crossing the occlusion with a guidewire therefore after initial reperfusion, which might have contributed to the neutral outcomes.
View Article and Find Full Text PDFCompact Arterial Monitoring Device Use in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): A Simple Validation Study in Swine.
Cureus
October 2024
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, USA.
Article Synopsis
- - Hemorrhage is the main cause of preventable death in trauma situations, leading to military and civilian advancements in medical practices, particularly through the use of tourniquets to manage extremity bleeding and save lives.
- - While tourniquets have significantly decreased deaths from bleeding in military settings, noncompressible hemorrhage still poses a major risk, especially before patients receive definitive medical care.
- - The study explores using a small, disposable pressure monitor during resuscitative endovascular balloon occlusion of the aorta (REBOA) to enhance blood pressure monitoring, facilitate better resuscitation practices, and reduce the need for blood products in extreme environments.
Prothrombin and activated partial thromboplastin times, thromboelastography, hematocrit, and platelet count in a feline hemorrhage/over-resuscitation model using lactated Ringer's solution or 6% tetrastarch 130/0.4.
J Vet Emerg Crit Care (San Antonio)
August 2024
Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
Article Synopsis
- The study aimed to evaluate the effects of different resuscitation fluids on blood coagulation and related metrics in a controlled hemorrhage model using six cats.
- Cats underwent three treatments over two months: no hemorrhage with sham resuscitation, resuscitation with lactated Ringer's solution (LRS), and resuscitation with Voluven (a starch solution). Blood tests were conducted at multiple time points.
- Results showed that both LRS and Voluven led to significant prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT), as well as reduced hematocrit (HCT) and platelet counts, indicating hypocoagulopathy
Acute normovolemic hemodilution in cardiac surgery: Rationale and design of a multicenter randomized trial.
Contemp Clin Trials
August 2024
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Article Synopsis
- The study evaluates acute normovolemic hemodilution (ANH) as a method to decrease the need for red blood cell (RBC) transfusions in patients undergoing elective cardiac surgery, aiming to reduce associated risks and costs.
- It is a randomized controlled trial conducted in various hospitals, where patients are assigned to either receive ANH before surgery or the best available alternative treatment.
- The primary goal is to see if ANH lowers the percentage of patients requiring RBC transfusion from 35% to 28%, with secondary outcomes including mortality and complications related to kidney and bleeding issues.
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