Cardiothoracic & vascular anesthesia
Large volume acute normovolemic hemodilution in patients undergoing cardiac surgery with intermediate-high risk of transfusion: A randomized controlled trial
Authors' conclusion
Compared with M-ANH, L-ANH during cardiac surgery inclined to be associated with reduced perioperative RBC transfusion and the volume of RBC transfusion was inversely proportional to the volume of ANH. In addition, LANH during cardiac surgery was associated with a lower incidence of postoperative excessive bleeding.
Study context
- Population
- Patients with TRUST ≥2 points undergoing cardiac surgery with cardiopulmonary bypass (CPB), Second Affiliated Hospital of Zhejiang University, May 2020 to January 2021159 screened
- Participants
- 110 patients
- Comparison
- Large volume vs moderate acute normovolemic hemodilution
- L-ANHn = 55
- Moderate acute normovolemic hemodilution (M-ANH)n = 55reference
- Primary endpoint
- Perioperative RBC transfusion units
Methodological detailsprospective, single-centre
- Prospective
- Single-centre
Primary result
As reported in the abstract
M-ANH
0
median · IQR 0–4.4 · unit
L-ANH
0
median · IQR 0–2.0 · unit
P = 0.012
Further findings
| Outcome | L-ANH | M-ANH | Rate difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Incidence of transfusion | 23.6% | 41.8% | 0.182 (0.007–0.343) | P = 0.042 | |
| −0.200.20.4Difference (linear scale) |
Removed blood volume
P < 0.001
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Risk of perioperative RBC transfusion | 0.43 (0.19–0.98) | P = 0.044 | |
| 0.20.5125Odds ratio (log scale) |
Correlation of ANH volume with perioperative red blood cell (RBC) transfusion units
- Spearman r
- −0.483
- 95% CI −0.708 to −0.168, P = 0.003
Safety
| Outcome | L-ANH | M-ANH | Rate difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Postoperative excessive bleeding | 3.6% | 18.2% | 0.146 (0.027–0.270) | P = 0.029 | |
| −0.200.20.4Difference (linear scale) |
Other composite outcome components (AF, pulmonary infection, cardiac surgery associated acute kidney injury (CSA-AKI) ≥2, incision infection, resternotomy)
- No significant difference for other second outcomes
Original publication
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