Cornelius Dyke1, Solomon Aronson2, Wulf Dietrich3, Axel Hofmann4, Keyvan Karkouti5, Marcel Levi6, Gavin J Murphy7, Frank W Sellke8, Linda Shore-Lesserson9, Christian von Heymann10, Marco Ranucci11. 1. Department of Cardiothoracic Surgery, University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, ND. Electronic address: cornelius.dyke@sanfordhealth.org. 2. Department of Anesthesiology, Duke University Medical Center, Durham, NC. 3. Institute for Research in Cardiac Anesthesia, Munich, Germany. 4. Institute of Anaesthesiology, University Hospital, Zurich, Switzerland; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia; Centre for Population Health Research, Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, Western Australia; Medical Society for Blood Management, Laxenburg, Austria. 5. Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 6. Department of Vascular Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 7. Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, United Kingdom. 8. Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. 9. Department of Anesthesiology, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra University School of Medicine, Manhasset, NY. 10. Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. 11. Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
Abstract
OBJECTIVES: Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and quantify bleeding and to facilitate future investigation into this difficult clinical problem. METHODS: The multidisciplinary International Initiative on Haemostasis Management in Cardiac Surgery identified a common definition of perioperative bleeding as an unmet need. The functionality and usefulness of the UDPB for clinical research was then tested using a large single-center, nonselected, cardiac surgical database. RESULTS: A multistaged definition for perioperative bleeding was created based on easily measured clinical end points, including total blood loss from chest tubes within 12 hours, allogeneic blood products transfused, surgical reexploration including cardiac tamponade, delayed sternal closure, and the need for salvage treatment. Depending on these components, bleeding is graded as insignificant, mild, moderate, severe, or massive. When applied to an established cardiac surgery dataset, the UDPB provided insight into the incidence and outcome of bleeding after cardiac surgery. CONCLUSIONS: The proposed UDPB in adult cardiac surgery provides a precise classification of bleeding that is useful in everyday practice as well as in clinical research. Once fully validated, the UDPB may be useful as an institutional quality measure and serve as an important end point in future cardiac surgical research.
OBJECTIVES: Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and quantify bleeding and to facilitate future investigation into this difficult clinical problem. METHODS: The multidisciplinary International Initiative on Haemostasis Management in Cardiac Surgery identified a common definition of perioperative bleeding as an unmet need. The functionality and usefulness of the UDPB for clinical research was then tested using a large single-center, nonselected, cardiac surgical database. RESULTS: A multistaged definition for perioperative bleeding was created based on easily measured clinical end points, including total blood loss from chest tubes within 12 hours, allogeneic blood products transfused, surgical reexploration including cardiac tamponade, delayed sternal closure, and the need for salvage treatment. Depending on these components, bleeding is graded as insignificant, mild, moderate, severe, or massive. When applied to an established cardiac surgery dataset, the UDPB provided insight into the incidence and outcome of bleeding after cardiac surgery. CONCLUSIONS: The proposed UDPB in adult cardiac surgery provides a precise classification of bleeding that is useful in everyday practice as well as in clinical research. Once fully validated, the UDPB may be useful as an institutional quality measure and serve as an important end point in future cardiac surgical research.
Authors: Nazish K Hashmi; Kamrouz Ghadimi; Amudan J Srinivasan; Yi-Ju Li; Robert D Raiff; Jeffrey G Gaca; Adam G Root; Yaron D Barac; Thomas L Ortel; Jerrold H Levy; Ian J Welsby Journal: Vox Sang Date: 2019-04-02 Impact factor: 2.144
Authors: J Trent Magruder; Stephen Belmustakov; Rika Ohkuma; Sarah Collica; Joshua C Grimm; Todd Crawford; John V Conte; William A Baumgartner; Ashish S Shah; Glenn R Whitman Journal: Gen Thorac Cardiovasc Surg Date: 2016-09-20
Authors: Katarzyna Czerwińska-Jelonkiewicz; Marek Cisowski; Andrzej Bochenek; Piotr Buszman; Krzysztof Milewski; Piotr Kunik; Magdalena Mularska; Krzysztof Kocot; Piotr Politowski; Jakub Brączkowski; Agata Trznadel; Michael S Aboodi; Paweł Buszman Journal: Cardiol J Date: 2018-11-28 Impact factor: 2.737
Authors: Eline A Vlot; Eric P A van Dongen; Laura M Willemsen; Jur M Ten Berg; Christian M Hackeng; Stephan A Loer; Peter G Noordzij Journal: Clin Appl Thromb Hemost Date: 2021 Jan-Dec Impact factor: 2.389
Authors: Fausto Biancari; Giovanni Mariscalco; Hakeem Yusuff; Geoffrey Tsang; Suvitesh Luthra; Francesco Onorati; Alessandra Francica; Cecilia Rossetti; Andrea Perrotti; Sidney Chocron; Antonio Fiore; Thierry Folliguet; Matteo Pettinari; Angelo M Dell'Aquila; Till Demal; Lenard Conradi; Christian Detter; Marek Pol; Peter Ivak; Filip Schlosser; Stefano Forlani; Govind Chetty; Amer Harky; Manoj Kuduvalli; Mark Field; Igor Vendramin; Ugolino Livi; Mauro Rinaldi; Luisa Ferrante; Christian Etz; Thilo Noack; Stefano Mastrobuoni; Laurent De Kerchove; Mikko Jormalainen; Steven Laga; Bart Meuris; Marc Schepens; Zein El Dean; Antti Vento; Peter Raivio; Michael Borger; Tatu Juvonen Journal: J Cardiothorac Surg Date: 2021-06-10 Impact factor: 1.637