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J Thorac Cardiovasc Surg 2005;129:1200-1201
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Randomized prospective trial for blood transfusion during adult cardiopulmonary bypass surgery

Department of Surgery University of Illinois at Chicago Chicago, IL 60612

The first 20% of the full text of this article appears below.

To the Editor:

Hemoglobin dilution is an expected physiologic response during cardiopulmonary bypass (CPB) surgery. Current controversy, however, centers around this question: what is a safe hematocrit level during CPB before the patient sustains less than an expected outcome? The main reason for the lack of consensus regarding blood transfusion may stem from the lack of a direct cause (hematocrit level) and effect (morbidity and mortality) relationship or an association or both causality and association. Although it has been found that low preoperative hemoglobin levels are correlated with poorer outcome,¹ it does not mean that correcting this number will result in improved outcome. This same argument holds true for intraoperative hematocrits with the understanding that new-onset intraoperative anemia is reversible and mainly caused by dilution, whereas preoperative anemia is pathologic and mainly caused by nondilutional processes. Also, despite understanding the reversibility concept, most decisions of intraoperative transfusion stem from personal and institutional experience, with no defined dimensions. In May 2004, the National Heart, Lung, and Blood Institute working group published an executive summary regarding future directions in cardiac surgery.² Creating a cardiovascular surgery clinical research network was one of the pillars, and I hope . . . [Full Text of this Article]