Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery

systematic reviews, observational studies and randomised controlled trials

Gavin J Murphy, Andrew D. Mumford, Chris A Rogers, Sarah Wordsworth, Elizabeth A Stokes, Veerle Verheyden, Tracy Kumar, Jessica Harris, Gemma Clayton, Lucy Ellis, Zoe Plummer, William Dott, Filiberto Serraino, Marcin J Wozniak, Tom Morris, Mintu Nath, Jonathan Ac Sterne, Gianni D Angelini, Barnaby C. Reeves

Research output: Contribution to journalArticle

Abstract

Background: Anaemia, coagulopathic bleeding and transfusion are strongly associated with organ failure, sepsis and death following cardiac surgery.

Objective: To evaluate the clinical effectiveness and cost-effectiveness of medical devices used as diagnostic and therapeutic tools for the management of anaemia and bleeding in cardiac surgery.

Methods and results: Workstream 1 – in the COagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC) study we demonstrated that risk assessment using baseline clinical factors predicted bleeding with a high degree of accuracy. The results from point-of-care (POC) platelet aggregometry or viscoelastometry tests or an expanded range of laboratory reference tests for coagulopathy did not improve predictive accuracy beyond that achieved with the clinical risk score alone. The routine use of POC tests was not cost-effective. A systematic review concluded that POC-based algorithms are not clinically effective. We developed two new clinical risk prediction scores for transfusion and bleeding that are available as e-calculators. Workstream 2 – in the PAtient-SPecific Oxygen monitoring to Reduce blood Transfusion during heart surgery (PASPORT) trial and a systematic review we demonstrated that personalised near-infrared spectroscopy-based algorithms for the optimisation of tissue oxygenation, or as indicators for red cell transfusion, were neither clinically effective nor cost-effective. Workstream 3 – in the REDWASH trial we failed to demonstrate a reduction in inflammation or organ injury in recipients of mechanically washed red cells compared with standard (unwashed) red cells
Original languageEnglish
Pages (from-to)1-406
Number of pages406
JournalProgramme Grants for Applied Research
Volume5
Issue number17
DOIs
Publication statusPublished - Sep 2017

Fingerprint

Point-of-Care Systems
Thoracic Surgery
Observational Studies
Randomized Controlled Trials
Hemorrhage
Equipment and Supplies
Anemia
Blood Platelets
Costs and Cost Analysis
Near-Infrared Spectroscopy
Therapeutics
Blood Transfusion
Cost-Benefit Analysis
Sepsis
Reference Values
Oxygen
Inflammation
Wounds and Injuries

Cite this

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery : systematic reviews, observational studies and randomised controlled trials. / Murphy, Gavin J; Mumford, Andrew D.; Rogers, Chris A; Wordsworth, Sarah; Stokes, Elizabeth A; Verheyden, Veerle; Kumar, Tracy; Harris, Jessica; Clayton, Gemma; Ellis, Lucy; Plummer, Zoe; Dott, William; Serraino, Filiberto; Wozniak, Marcin J; Morris, Tom; Nath, Mintu; Sterne, Jonathan Ac; Angelini, Gianni D; Reeves, Barnaby C.

In: Programme Grants for Applied Research, Vol. 5, No. 17, 09.2017, p. 1-406.

Research output: Contribution to journalArticle

Murphy, GJ, Mumford, AD, Rogers, CA, Wordsworth, S, Stokes, EA, Verheyden, V, Kumar, T, Harris, J, Clayton, G, Ellis, L, Plummer, Z, Dott, W, Serraino, F, Wozniak, MJ, Morris, T, Nath, M, Sterne, JA, Angelini, GD & Reeves, BC 2017, 'Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials', Programme Grants for Applied Research, vol. 5, no. 17, pp. 1-406. https://doi.org/10.3310/pgfar05170
Murphy, Gavin J ; Mumford, Andrew D. ; Rogers, Chris A ; Wordsworth, Sarah ; Stokes, Elizabeth A ; Verheyden, Veerle ; Kumar, Tracy ; Harris, Jessica ; Clayton, Gemma ; Ellis, Lucy ; Plummer, Zoe ; Dott, William ; Serraino, Filiberto ; Wozniak, Marcin J ; Morris, Tom ; Nath, Mintu ; Sterne, Jonathan Ac ; Angelini, Gianni D ; Reeves, Barnaby C. / Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery : systematic reviews, observational studies and randomised controlled trials. In: Programme Grants for Applied Research. 2017 ; Vol. 5, No. 17. pp. 1-406.
@article{3a1ea2abac424647a12083c1df306399,
title = "Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials",
abstract = "Background: Anaemia, coagulopathic bleeding and transfusion are strongly associated with organ failure, sepsis and death following cardiac surgery.Objective: To evaluate the clinical effectiveness and cost-effectiveness of medical devices used as diagnostic and therapeutic tools for the management of anaemia and bleeding in cardiac surgery.Methods and results: Workstream 1 – in the COagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC) study we demonstrated that risk assessment using baseline clinical factors predicted bleeding with a high degree of accuracy. The results from point-of-care (POC) platelet aggregometry or viscoelastometry tests or an expanded range of laboratory reference tests for coagulopathy did not improve predictive accuracy beyond that achieved with the clinical risk score alone. The routine use of POC tests was not cost-effective. A systematic review concluded that POC-based algorithms are not clinically effective. We developed two new clinical risk prediction scores for transfusion and bleeding that are available as e-calculators. Workstream 2 – in the PAtient-SPecific Oxygen monitoring to Reduce blood Transfusion during heart surgery (PASPORT) trial and a systematic review we demonstrated that personalised near-infrared spectroscopy-based algorithms for the optimisation of tissue oxygenation, or as indicators for red cell transfusion, were neither clinically effective nor cost-effective. Workstream 3 – in the REDWASH trial we failed to demonstrate a reduction in inflammation or organ injury in recipients of mechanically washed red cells compared with standard (unwashed) red cells",
author = "Murphy, {Gavin J} and Mumford, {Andrew D.} and Rogers, {Chris A} and Sarah Wordsworth and Stokes, {Elizabeth A} and Veerle Verheyden and Tracy Kumar and Jessica Harris and Gemma Clayton and Lucy Ellis and Zoe Plummer and William Dott and Filiberto Serraino and Wozniak, {Marcin J} and Tom Morris and Mintu Nath and Sterne, {Jonathan Ac} and Angelini, {Gianni D} and Reeves, {Barnaby C.}",
note = "Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 5, No. 17. See the NIHR Journals Library website for further project information.",
year = "2017",
month = "9",
doi = "10.3310/pgfar05170",
language = "English",
volume = "5",
pages = "1--406",
journal = "Programme Grants for Applied Research",
number = "17",

}

TY - JOUR

T1 - Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery

T2 - systematic reviews, observational studies and randomised controlled trials

AU - Murphy, Gavin J

AU - Mumford, Andrew D.

AU - Rogers, Chris A

AU - Wordsworth, Sarah

AU - Stokes, Elizabeth A

AU - Verheyden, Veerle

AU - Kumar, Tracy

AU - Harris, Jessica

AU - Clayton, Gemma

AU - Ellis, Lucy

AU - Plummer, Zoe

AU - Dott, William

AU - Serraino, Filiberto

AU - Wozniak, Marcin J

AU - Morris, Tom

AU - Nath, Mintu

AU - Sterne, Jonathan Ac

AU - Angelini, Gianni D

AU - Reeves, Barnaby C.

N1 - Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 5, No. 17. See the NIHR Journals Library website for further project information.

PY - 2017/9

Y1 - 2017/9

N2 - Background: Anaemia, coagulopathic bleeding and transfusion are strongly associated with organ failure, sepsis and death following cardiac surgery.Objective: To evaluate the clinical effectiveness and cost-effectiveness of medical devices used as diagnostic and therapeutic tools for the management of anaemia and bleeding in cardiac surgery.Methods and results: Workstream 1 – in the COagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC) study we demonstrated that risk assessment using baseline clinical factors predicted bleeding with a high degree of accuracy. The results from point-of-care (POC) platelet aggregometry or viscoelastometry tests or an expanded range of laboratory reference tests for coagulopathy did not improve predictive accuracy beyond that achieved with the clinical risk score alone. The routine use of POC tests was not cost-effective. A systematic review concluded that POC-based algorithms are not clinically effective. We developed two new clinical risk prediction scores for transfusion and bleeding that are available as e-calculators. Workstream 2 – in the PAtient-SPecific Oxygen monitoring to Reduce blood Transfusion during heart surgery (PASPORT) trial and a systematic review we demonstrated that personalised near-infrared spectroscopy-based algorithms for the optimisation of tissue oxygenation, or as indicators for red cell transfusion, were neither clinically effective nor cost-effective. Workstream 3 – in the REDWASH trial we failed to demonstrate a reduction in inflammation or organ injury in recipients of mechanically washed red cells compared with standard (unwashed) red cells

AB - Background: Anaemia, coagulopathic bleeding and transfusion are strongly associated with organ failure, sepsis and death following cardiac surgery.Objective: To evaluate the clinical effectiveness and cost-effectiveness of medical devices used as diagnostic and therapeutic tools for the management of anaemia and bleeding in cardiac surgery.Methods and results: Workstream 1 – in the COagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC) study we demonstrated that risk assessment using baseline clinical factors predicted bleeding with a high degree of accuracy. The results from point-of-care (POC) platelet aggregometry or viscoelastometry tests or an expanded range of laboratory reference tests for coagulopathy did not improve predictive accuracy beyond that achieved with the clinical risk score alone. The routine use of POC tests was not cost-effective. A systematic review concluded that POC-based algorithms are not clinically effective. We developed two new clinical risk prediction scores for transfusion and bleeding that are available as e-calculators. Workstream 2 – in the PAtient-SPecific Oxygen monitoring to Reduce blood Transfusion during heart surgery (PASPORT) trial and a systematic review we demonstrated that personalised near-infrared spectroscopy-based algorithms for the optimisation of tissue oxygenation, or as indicators for red cell transfusion, were neither clinically effective nor cost-effective. Workstream 3 – in the REDWASH trial we failed to demonstrate a reduction in inflammation or organ injury in recipients of mechanically washed red cells compared with standard (unwashed) red cells

U2 - 10.3310/pgfar05170

DO - 10.3310/pgfar05170

M3 - Article

VL - 5

SP - 1

EP - 406

JO - Programme Grants for Applied Research

JF - Programme Grants for Applied Research

IS - 17

ER -