Background: Despite the growing medical and public interest in
reducing exposure to allogeneic blood, little is known about the use of
alternatives to allogeneic transfusion. This study was conducted to determine
the availability of these technologies in Canadian hospitals and was
undertaken under the auspices of the International Study of Peri-Operative
Transfusion (ISPOT), a 10-country study of the effectiveness of, attitudes
toward, and practices related to the use of alternatives to allogeneic
transfusion.Methods: A cross-sectional national mail survey of Canadian
hospitals with greater than 50 medical/surgical beds. Chiefs of
anesthesia, surgery, and the divisions of cardiac, orthopedic, vascular, and
urology were initially mailed a brief postcard asking which of seven
technologies were used in their center. This was then followed up with a
one-page questionnaire asking how frequently the technologies were used, their
thoughts on the appropriateness of the use of the technologies, barriers to
their greater use, and reasons for nonuse of the technologies.Results: Response rates to the postcard survey ranged from
70%–98%, depending on the technology and type of surgery, and ranged
from 27%–53% for the follow-up questionnaire. All technologies were used
most frequently in cardiac surgery. Aprotinin, tranexamic acid, aminocaproic
acid, desmopressin, and cell salvage were reported used in over 70% of cardiac
surgery centers. Of these, tranexamic acid and cell salvage were the only ones
used routinely in some centers. Acute normovolemic hemodilution and
erythropoietin were used in 45% and 20% of cardiac centers, respectively. The
drugs were used in less than 15% of orthopedic, vascular, and urologic
divisions, with the exception of desmopressin in urologic and vascular surgery
and aminocaproic acid in urologic surgery. The techniques of cell salvage and
acute normovolemic hemodilution were used in 30%–45% of these divisions,
with the exception of cell salvage, which was used in less than 15% of urology
units. In more than 60% of cases, the technologies were considered to be used
“about right,” although an important minority felt that they were
underused.Conclusions: In general, alternatives to perioperative allogeneic
transfusion were rarely used except in cardiac surgery.
Acute normovolemic hemodilution and intraoperative cell salvage in aortic surgery
