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KMID : 0356920070520050530
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Korean Journal of Anesthesiology
2007 Volume.52 No. 5 p.530 ~ p.536
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Cardiac Surgeries without Transfusion
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Lee Jong-Hyun
Shin Da-Huin
Hoo Gum-Jn
Lee Chang-Ha
Na Chan-Young
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Abstract
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Background: Jehovah’s Witnesses are well known for their refusal of blood transfusions which, challenges the safety of performing cardiac surgeries. Their stand regarding blood transfusions has garnered criticism from some medical and legal sources, but has also added incentive for the development of many bloodless surgery techniques. To assess the impact on the continuing progress of blood saving protocols and increasing operative risk; herein our results in this specific population are reported.
Methods: The medical records of Jehovah’s Witnesses, who underwent cardiac surgeries without blood transfusions, between Feb 1996 and Sep 2005, were retrospectively reviewed.
Results: 103 surgical procedures were performed on 102 patients. The age of patients varied from 2 months to 78 years, with a sex ratio of 60：42 (Male：Female). Cardiopulmonary bypass (CPB) was used in 81 cases. The mean hemoglobin (Hb) and hematocrit (Hct) levels were 13.2 g/dl (8.1?17.3), and 39.2% (24.3?52.5) before surgery, and 11.8 g/dl (8.0?16.5), and 35.3% (24?49) after surgery, respectively. Recombinant human erythropoietin (rHuEPO) and iron were used in 95 and 69 cases before and after surgery, respectively. High dose aprotinin (2 million KIU IV loading dose, 2 million KIU into the pump prime volume and 500,000 KIU per hour of surgery as a continuous intravenous infusion) was used in 67 cases. Acute normovolemic hemodilutions were performed in 7 cases. Cell saver was used in all procedures. Re-operations were needed in two cases due to wound infections and one patient died-of arrhythmias on the 2nd post-operative day.
Conclusions: Bloodless cardiac surgery can be performed on Jehovah’s Witnesses, but effective care of such patients requires close collaborative team efforts and advance planning to ensure favorable outcomes. At our hospital, preoperative iron and rHuEPO, as well as high dose aprotinin and cell saver are routinely used where indicated. (Korean J Anesthesiol 2007; 52: 530∼6)
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KEYWORD
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bloodless, cardiac surgery, erythropoietin, Jehovah’s Witnesses
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