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

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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

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    Murphy, G. J., Mumford, A. D., Rogers, C. A., Wordsworth, S., Stokes, E. A., Verheyden, V., Kumar, T., Harris, J., Clayton, G., Ellis, L., Plummer, Z., Dott, W., Serraino, F., Wozniak, M. J., Morris, T., Nath, M., Sterne, J. A., Angelini, G. D., & Reeves, B. C. (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, 5(17), 1-406. https://doi.org/10.3310/pgfar05170