Effects of Acute Normovolemic Hemodilution on Post-Cardiopulmonary Bypass Coagulation Tests and Allogeneic Blood Transfusion in Thoracic Aortic Repair Surgery: An Observational Cohort Study

Background and Aim: Perioperative blood transfusion is associated with increased morbidity and mortality. Acute normovolemic hemodilution (ANH) is a blood conservation strategy associated with variable success, and rarely studied in more complex cardiac procedures. The study aim was to evaluate whether acute ANH improves coagulopathy and reduces blood transfusions in thoracic aortic surgeries. Methods: Single-center observational cohort study comparing ANH and standard institutional practice in patients who underwent thoracic aortic repair from 2019 to 2021. Results: 89 patients underwent ANH and 116 standard practice. There were no significant differences between the groups in terms of demographic or major perioperative characteristics. In the ANH group coagulation tests before and after transfusion of autologous blood showed decreased INR and increased platelets, fibrinogen, all with p<0.0005. Coagulation results in the ANH and control groups were not statistically different. The average number of transfused allogeneic products per patient was lower in the ANH vs control group: FFP 1.1 +/-1.6 vs 1.9 +/-2.3 (p=0.003), platelets 0.6 +/-0.8 vs 1.2 +/-1.3 (p=0.0008), and cryoprecipitate 0.3 +/-0.7 vs 0.7 +/-1.1 (p=0.008). Reduction in RBC transfusion was not statistically significant. The percentage of patients who received any transfusion was 53.9% in ANH and 59.5% in the control group (p=0.42). There was no significant difference in major adverse outcomes. Conclusions: ANH is a safe blood conservation strategy for surgical repairs of the thoracic aorta. Laboratory data suggests that ANH can improve coagulopathy after separation from CPB, and significantly reduce the number of transfused FFP, platelets and cryoprecipitate.

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Effects of acute normovolemic hemodilution on post‐cardiopulmonary bypass coagulation tests and allogeneic blood transfusion in thoracic aortic repair surgery: An observational cohort study

Journal of Cardiac Surgery ◽

10.1111/jocs.15943 ◽

2021 ◽

Vol 36 (11) ◽

pp. 4075-4082

Author(s):

Domagoj Mladinov ◽

Kyle W. Eudailey ◽

Luz A. Padilla ◽

Joseph B. Norman ◽

Benjamin Leahy ◽

...

Keyword(s):

Cohort Study ◽

Cardiopulmonary Bypass ◽

Blood Transfusion ◽

Observational Cohort Study ◽

Allogeneic Blood ◽

Acute Normovolemic Hemodilution ◽

Coagulation Tests ◽

Observational Cohort ◽

Normovolemic Hemodilution ◽

Post Cardiopulmonary Bypass

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Psychological Traits and Behavioural Influences in Patients with Dystonia—An Observational Cohort Study in a Romanian Neurology Department

Life ◽

10.3390/life11070612 ◽

2021 ◽

Vol 11 (7) ◽

pp. 612

Author(s):

Eugenia Irene Davidescu ◽

Irina Odajiu ◽

Delia Tulbă ◽

Iulia Mitrea ◽

Camelia Cucu ◽

...

Keyword(s):

Cohort Study ◽

Informed Consent ◽

Personality Traits ◽

Patient Group ◽

Observational Cohort Study ◽

Control Group ◽

Inclusion Criteria ◽

Control Subjects ◽

Observational Cohort ◽

Idiopathic Dystonia

(1) Background: Emerging evidence indicates that non-motor symptoms significantly influence the quality of life in dystonic patients. Therefore, it is essential to evaluate their psychological characteristics and personality traits. (2) Methods: Subjects with idiopathic dystonia and a matched control group were enrolled in this prospective observational cohort study. Inclusion criteria for patient group included idiopathic dystonia diagnosis, evolution exceeding 1 year, and signed informed consent. Inclusion criteria for the control group included lack of neurological comorbidities and signed informed consent. All subjects completed the DECAS Personality Inventory along with an additional form of demographic factors. Data (including descriptive statistics and univariate and multivariate analysis) were analyzed with SPSS. (3) Results: In total, 95 participants were included, of which 57 were in the patient group. Females prevailed (80%), and the mean age was 54.64 ± 12.8 years. The most frequent clinical features of dystonia were focal distribution (71.9%) and progressive disease course (94.73%). The patients underwent regular treatment with botulinum toxin (85.95%). In addition, patients with dystonia obtained significantly higher openness scores than controls, even after adjusting for possible confounders (p = 0.006). Personality traits were also different between the two groups, with patients more often being fantasists (p = 0.007), experimenters (p = 0.022), sophists (p = 0.040), seldom acceptors (p = 0.022), and pragmatics (p = 0.022) than control subjects. (4) Conclusion: Dystonic patients tend to have different personality profiles compared to control subjects, which should be taken into consideration by the treating neurologist.

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Absence of Beneficial Effect of Acute Normovolemic Hemodilution Combined with Aprotinin on Allogeneic Blood Transfusion Requirements in Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200202000-00009 ◽

2002 ◽

Vol 96 (2) ◽

pp. 276-282 ◽

Cited By ~ 30

Author(s):

Laurent Höhn ◽

Alexandre Schweizer ◽

Marc Licker ◽

Denis R. Morel

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

High Risk ◽

Blood Transfusion ◽

Allogeneic Blood ◽

Surgical Patients ◽

Control Group ◽

Acute Normovolemic Hemodilution ◽

Normovolemic Hemodilution ◽

Normal Cardiac Function

Background The efficacy of acute normovolemic hemodilution (ANH) in decreasing allogeneic blood requirements remains controversial during cardiac surgery. Methods In a prospective, randomized study, 80 adult cardiac surgical patients with normal cardiac function and no high risk of ischemic complications were subjected either to ANH, from a mean hematocrit of 43% to 28%, or to a control group. Aprotinin and intraoperative blood cell salvage were used in both groups. Blood (autologous or allogeneic) was transfused when the hematocrit was less than 17% during cardiopulmonary bypass, less than 25% after cardiopulmonary bypass, or whenever clinically indicated. Results The amount of whole blood collected during ANH ranged from 10 to 40% of the patients' estimated blood volume. Intraoperative and postoperative blood losses were not different between control and ANH patients (total blood loss, control: 1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36). Allogeneic blood was given in 29% of control patients (median, 2; range, 1-3 units of packed erythrocytes) and in 33% of ANH patients (median, 2; range, 1-5 units of packed erythrocytes; P = 0.219). Preoperative and postoperative platelet count, prothrombin time, and partial thromboplastin time were similar between groups. Perioperative morbidity and mortality were not different in both groups, and similar hematocrit values were observed at hospital discharge (33.7 +/- 3.9% in the control group and 32.6 +/- 3.7% in the ANH group; nonsignificant) Conclusions Hemodilution is not an effective means to lower the risk of allogeneic blood transfusion in elective cardiac surgical patients with normal cardiac function and in the absence of high risk for coronary ischemia, provided standard intraoperative cell saving and high-dose aprotinin are used.

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Failed Foramen Magnum Decompression in Chiari I Malformation Is Associated With Failure to Restore Normal Intracranial Compliance: An Observational Cohort Study

Neurosurgery ◽

10.1093/neuros/nyaa079 ◽

2020 ◽

Vol 86 (6) ◽

pp. E552-E557

Author(s):

Edward W Dyson ◽

Aswin Chari ◽

Ahmed K Toma ◽

Lewis W Thorne ◽

Laurence D Watkins

Keyword(s):

Cohort Study ◽

Normal Control ◽

Significant Proportion ◽

Foramen Magnum ◽

Observational Cohort Study ◽

Control Group ◽

Foramen Magnum Decompression ◽

Persistent Symptoms ◽

Intracranial Compliance ◽

Observational Cohort

Abstract BACKGROUND The standard treatment for symptomatic Chiari malformation (CM) I is foramen magnum decompression (FMD) to facilitate cerebral spinal fluid flow through the foramen magnum, improve intracranial compliance, and alleviate symptoms (commonly headache). This procedure has a variable success rate, with a significant proportion of patients having persistent symptoms after surgery. OBJECTIVE To investigate intracranial pressure (ICP) hydrodynamics in symptomatic surgery-naïve patients with CM I and symptomatic patients who have had prior FMD. METHODS We undertook a retrospective, observational cohort study, extracting data from our departmental ICP database. Patients with untreated (“Virgin”) Chiari malformations (VCM), patients with previous “failed” FMD (ie, with persistent classical Chiari symptoms) (fFMD) and a normal control group, all with existing continuous ICP monitoring date were included. Median ICP (mICP) and median pulse amplitude (mPA) were compared between the groups. RESULTS A total of 33 CM patients (22 VCM and 11 fFMD) and 42 normal controls were included for analysis. mICP did not differ significantly between the normal control, VCM, and fFMD groups. mPA in the VCM and fFMD groups was significantly higher than the control group (P < .01 and P < .05, respectively). CONCLUSION In this cohort, patients with persistent symptoms after FMD have persistently impaired intracranial compliance, similar to patients who have not undergone surgery at all when compared with a control group. The reasons for this are not clear, and further research is required to establish the causation and optimum management for failed FMD.

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