Quarterly Literature Update

The following contains the quarterly summary of peer-reviewed publications related “exclusively” to ANH for the months of July to September, 2008 (and possibly a few publications missed during the prior quarters) taken from the National Library of Medicine databases. My commentary (italics) may be added to reports of special import. NLIM now lists abstracts before they are formally published, as “Epubs.” For simplicity, Epubs are listed separately.

Anon: The infusion therapy of the acute bleeding Khirurgiia (Mosk) 8:68-72. (PMID: 18833153) Slightly obscure article that claims that ANH produces dilutional anemic hypoxia.

Crystal GJ et al: Hemodilution does not alter the coronary vasodilating effects of endogenous or exogenous nitric oxide. Can J Anaesth 55:507-14. (PMID: 18676385) A highly sophisticated ANH canine study that examined the effect of various nitric oxide (NO) agents - several coronary blood flow experiments were performed. The results indicated that during ANH, coronary vasodilation was not mediated by NO.

Dahaba AA et al: Acta Anaesthesiol Scand, May 12. (PMID: 18477087) This article was reviewed in ANH Bulletin #96.

Ging A et al: Bloodless cardiac surgery and the pediatric patient: a case study. Perfusion 23:131-134. (PMID: 18840583) A case report describing several blood conservation techniques, including ANH, for a 5.9 kg patient undergoing cardiac surgery.

Haas T et al: Eur J Anaesthesiol 25:473-8. (PMID: 18298874) This article was reviewed in ANH Bulletin #95 as an Epub.

Hughes DB et al: The contemporary approach to the care of Jehovah's witnesses. J Trauma 65:237-47. (PMID: 18580506) This is a review article that examines various treatment modalities in this patient population.

Jalali A et al: Acute normovolaemic haemodilution with crystalloids in coronary artery bypass graft surgery: a preliminary survey of haemostatic markers. Acta Cardiol 63:335-9. (PMID: 18664024) They compared the effect of ANH on blood transfusion and various blood coagulation parameters in patients undergoing cardiac surgery. Although, ANH was associated with “non-significant” changes in coagulation parameters, the patients required less red blood cell and fresh frozen blood products.

Jarnagin WR et al: A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg 248:360-9. (PMID: 18791356) One hundred and 30 patients undergoing major hepatic resection were subjected to ANH or a standard anesthetic technique. ANH reduced the need for allogeneic blood and was associated with higher postoperative Hb levels. This study from Sloan-Kettering in New York, further concluded that ANH is safe and should be used for routine use; this is the first study in almost 5 years to draw such a conclusion!

Joubert KE: Acute normovolaemic haemodilution--2 case studies. J S Afr Vet Assoc 79:46-9. (PMID: 18678193) ANH was used in a dog and a kitten as a blood conservation tool.

Lemeneva NV et al: Anesteziol Reanimatol 2:22-6. (PMID: 18543425) This article was reviewed in ANH Bulletin #96. The abstract initially had no authors, but now does.

Lomivorotov VV et al: Efficiency of using gelofusine and voluven in acute normovolemic hemodilution during cardiosurgical interventions. Anesteziol Reanimatol 3:10-3. (PMID: 18652167) Not much detail is provided in this Russian study in 67 patients undergoing ANH prior to cardiac surgery. Gelofusine, a succinylated gelatin, similar to albumen, was compared to voluven, a hetastarch, for fluid replacement. They conclude that the gelatin product was as effective as hetastarch, but considerably cheaper.

Lundby C et al: J Appl Physiol 105:581-7. (PMID: 18535134) This article was reviewed in ANH Bulletin #96 as an Epub.

Martini J et al: Survival time in severe hemorrhagic shock after perioperative hemodilution is longer with PEG-conjugated human serum albumin than with HES 130/0.4: a microvascular perspective. Crit Care 12:R54. (PMID: 18423033) From the Cabrales group, using their famous hamster experimental setup, they compared polyethylene glycol (PEG) encapsulated human serum albumen with hetastarch as a replacement fluid during ANH. Animals were subsequently subjected to simulated surgical hemorrhage – the group receiving the PEG-encapsulated albumen had better survival; they attribute this to better mean arterial pressure during hemorrhage.

Nogami Y et al: Liposome-encapsulated hemoglobin transfusion rescues rats undergoing progressive hemodilution from lethal organ hypoxia without scavenging nitric oxide. Ann Surg 248:310-9. (PMID: 18650643) In this rat study, a liposome-encapsulated hemoglobin (Hb) was used for fluid replacement during progressive hemodilution. Compared to the control group, in which all animals died, the Hb product prevented death during progressive ANH. Nitric oxide metabolites were unchanged by the encapsulated Hb.

Parkin et al: (PMID: 18321618) This article was reviewed in ANH Bulletin #95 as an Epub.

Takayanagi A et al: Urology 72: 401-5. (PMID: 18295317) This article was reviewed in ANH Bulletin #95 as an Epub.

Veikutiene A et al: Transfusion of autologous blood Medicina (Kaunas) 44:482-8. (PMID: 18660644) This is a review article from Lithuania that examines several autologous blood techniques..

Epub

Epstein NE: Bloodless spinal surgery: a review of the normovolemic hemodilution technique. Surg Neurol, Apr 17. (PMID: 18423553) This article reviewed publications that reported using ANH for major spine surgery. ANH reduced the frequency of allergenic blood transfusion in the cited studies.

Website Update

Website updates are designed to review interesting new internet resources, which are particularly unique, informative, cutting-edge etc. There is so much information on the world-wide-web that keeping up with all the various sites is impossible. So, from time-to-time, I examine a few search terms to find out what’s new! I was planning to provide an update on the website maintained by the Society for the Advancement of Blood Management; www.sabm.org, which has evolved into a brilliant website, probably one of the best on the internet on blood management.

However, another website caught my attention, the content of which I thought controversial. This is the website for the Blood Conservation Program at Beaufort Memorial Hospital, which is in Beaufort, South Carolina. Beaufort Memorial Hospital is cited an affiliate of Duke University. While the website for the program is not particularly unique or outstanding, www.bmhsc.org, one feature caught my attention.

In addition to the standard sections that describes the program, leadership and the various components, a brochure that may be downloaded, provides a summary of the program for patients and interested lay persons; www.bmhsc.org.

What is unique about this brochure is that it describes the facility as a “Blood Conservation Hospital.” This is a new term that I have never seen before, and obviously begs the question of what defines a blood conservation hospital compared to a “non-blood conservation hospital.” The term seems to imply that the primary focus of the facility is indeed blood conservation; however, as we all know, blood management programs typically do not have buy-in of all medical staff at a particular facility.

So, the broader question is whether this constitutes accurate or realistic marketing. Is this “hospital” a new approach to patient care? As the field of blood management grows, these are issues which regulatory bodies involved in creating standards for healthcare organizations will have to clarify and define.

I recently had an opportunity to visit a facility in Florida which boasted a “Bloodless Surgery Program” and a dedicated coordinator. To my dismay, this was a “virtual” program. There was no program in reality; a few policies and procedures; but, no leadership or personnel.

Hospitals will do anything to remain competitive in the marketplace, and if a local hospital starts a program that attracts patients, very soon, a similar program will start at a competing facility.