Heart Attack Patients Benefit as Interventional Cardiologists Increasingly Perform PCI Through Radial Artery Access in Wrist

Technique Is More Challenging But Bleeding Complications Lower, No Increase in Mortality

Las Vegas, Nev.  — Even when treating critically ill heart attack patients, interventional cardiologists are increasingly adopting a safer—though more technically challenging—procedure for threading balloon-tipped catheters and stents into the heart. According to a study reported this week at the SCAI 2014 Scientific Sessions, use of the radial artery in the wrist as the access point for percutaneous coronary intervention (PCI) is growing steadily in heart attack patients and results in significantly fewer bleeding complications and no increase in mortality.

Radial-artery access is an alternative to use of the femoral artery in the groin, the traditional approach. It has been found to reduce bleeding complications, andbe more comfortable for patients and reduce costs; however, it may be more time-consuming and requires additional physician training.

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Report: Bloodless surgery offers best chance for survival

The New Jersey Department of Health and Senior Services “Cardiac Surgery in New Jersey” report card has been released. It shows Englewood Hospital has a 100 percent survival rate for coronary artery bypass surgery.

Since 2000, Englewood Hospital’s Heart and Vascular Institute of New Jersey has successfully offered a range of non-surgical and minimally-invasive surgical options to cardiac surgery candidates. More than 80% of all cardiac surgeries performed at Englewood Hospital are performed without blood transfusions, using bloodless surgery techniques. Englewood Hospital is a leader in improving patient outcomes through the practice of bloodless medicine and surgery, which has been shown to reduce the risk of infection and improve survival after cardiac surgery, says a press release.

The report card used data from 2009, the most recent data available for its findings. It shows that Englewood Hospital achieved a 100% survival rate for that year.

Source: Digital Journal

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Bloodless Heart Surgery Risk Overstated

Patients who refuse blood transfusions during cardiac surgery may not necessarily be at an increased risk for surgical complications or long-term mortality, researchers found.

Compared with patients who had transfusions, Jehovah’s Witnesses — a religious group that forbids blood sharing — had significantly lower rates of myocardial infarction, additional operations for bleeding, and prolonged ventilation, as well as shorter hospital stays, Colleen Koch, MD, of the Cleveland Clinic, and colleagues reported online in the Archives of Internal Medicine.

They also had significantly better 1-year survival (P=0.007) and comparable 20-year survival, they reported.

Source: MedPage Today

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Outcome of Patients Who Refuse Transfusion After Cardiac Surgery – The Journal of the American Medical Association

Jehovah’s Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions.

Methods  A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival.

Results  Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = .01); additional operation for bleeding, 3.7% vs 7.1% (P = .03); prolonged ventilation, 6% vs 16% (P < .001); intensive care unit length of stay (15th, 50th, and 85th percentiles), 24, 25, and 72 vs 24, 48, and 162 hours (P < .001); and hospital length of stay (15th, 50th, and 85th percentiles), 5, 7, and 11 vs 6, 8, and 16 days (P < .001). Witnesses had better 1-year survival (95%; 95% CI, 93%-96%; vs 89%; 95% CI, 87%-90%; P = . 007) but similar 20-year survival (34%; 95% CI, 31%-38%; vs 32% 95% CI, 28%-35%; P = . 90).

Conclusions  Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.

Original Article July 2012: The Journal of the American Medical Association

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Englewood Hospital: 100% Survival Rate in Heart Bypass Surgery

Englewood Hospital and Medical Center has a perfect record for cardiac bypass graft (CABG) surgery with no deaths reported in the state’s latest report card released this week. The findings of the New Jersey Department of Health and Senior Services “Cardiac Surgery in New Jersey” report, which takes a look at the risk adjusted mortality rate for coronary artery bypass graft surgery in 2009, the most recent data available, shows that Englewood Hospital achieved a 100% survival rate. Englewood Hospital is one of only three hospitals in New Jersey with no CABG surgery deaths during the reported period.

More than 80% of all cardiac surgeries performed at Englewood Hospital are performed without blood transfusions, using bloodless surgery techniques.

Source: MarketWatch The Wall Street Journal

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Bloodless surgeries’ saving lives, money at Penrose – Colorado Springs, CO USA

Bloodless surgery seems counter-intuitive, but cardiovascular surgeons at Penrose-St. Francis Health Services make it routine in doing their jobs. Doing so, they say, saves money and lives. “Whenever you have to use blood transfusions, you increase the chance the patient will die,” said Dr. John Mehall, who is part of the cardiovascular and thoracic surgical program at …

Source:  Colorado Springs Business Journal

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Englewood Hospital to train military, others in bloodless surgery techniques

Englewood Hospital and Medical Center will receive nearly $4.7 million in federal funding to train military and civilian physicians in bloodless surgery and other medical procedures…

Source: NorthJersey.com

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Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery

Red blood cell transfusion in patients having cardiac surgery is strongly associated with both infection and ischemic postoperative morbidity, hospital stay, increased early and late mortality, and hospital costs.

Source: American Heart Association

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Banked Blood Loses Ability to Deliver Oxygen to Tissues

Almost immediately after it is donated, human blood begins to lose a key gas that opens up blood vessels to facilitate the transfer of oxygen from red blood cells to oxygen-starved tissues. Thus, millions of patients are apparently receiving transfusions with blood that is impaired in its ability to deliver oxygen.

Source: Duke University

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Duration of Red-Cell Storage and Complications after Cardiac Surgery

In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.

Source: New England Journal of Medicine

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Doctors try to find middle ground for Jehovah’s Witnesses who believe certain medical procedures violate their faith

Techniques before and during surgery include using medications to boost the bone marrow production of red blood cells, which increases hemoglobin levels; thinning a patient’s blood; and drawing a patient’s blood into a heart-lung machine to conserve healthy blood to reintroduce when surgery is completed. After surgery, he said he may use artificial products that promote blood clots, and bone marrow-boosting medications.

Source: Chicago Tribune

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Blood Transfusion and Anemia Management in Traumatic Brain Injury

Although liberal blood transfusion has become a standard means of treating anemia in brain-injured intensive care patients, recent data has shown that transfusion could be associated with increased mortality and composite complications including multi-organ failure. The findings in this article are of particular interest in the management of traumatic brain injury (TBI), since they focus on anemia and transfusions.

Source: National Anemia Action Council

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Blood transfusions found to harm some patients

For almost 9000 patients who had heart surgery in the UK between 1996 and 2003, receiving a red cell transfusion was associated with three times the risk of dying in the following year and an almost sixfold risk of dying within 30 days of surgery compared with not receiving one. Transfusions were also associated with more infections and higher incidences of stroke, heart attack and kidney failure – complications usually linked to a lack of oxygen in body tissues (Circulation, vol 116, p 2544).

Source: NewScientist.com

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Variant of Mad Cow Disease May Be Transmitted by Blood Transfusions, According to Animal Study

Researchers are continually studying the biology of blood products to understand how certain diseases are transmitted in an effort to reduce this risk during blood transfusions. According to a study in sheep prepublished online in Blood, the official journal of the American Society of Hematology, the risk of transmitting bovine spongiform encephalopathy (BSE, commonly known as “mad cow disease”) by blood transfusion is surprisingly high…

Source: American Society of Hematology

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Bloodless Prostate Surgery

Robotic prostate surgery is virtually “bloodless” and involves five small
“keyhole” incisions in the patient’s abdomen, through which fine instruments
are inserted, along with a miniscule camera that displays magnified images
from inside the body.

The robotic control system enables the surgeon’s hand
movements to be more precise, resulting in less trauma to surrounding tissue,
and minimal blood loss.

Source:  Dr. David Samadi, Mount Sinai Medical Center

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Blood Substitute’s Effectiveness And Safety Addressed In Large Clinical Trial

A predicted shortfall of over 4 million units of blood worldwide is driving the need to develop an alternative to red blood cells.

Academic and industry researchers participated in a Phase III multi-center clinical trial and found that use of a blood substitute was relatively safe in patients under 80 years old who have a moderate need for transfusion, up to the equivalent of three units of regular blood.

Published in the June 2008 edition of the Journal of Trauma, this study is the first Phase III trial to compare a blood substitute to regular blood and was conducted at 46 sites in the United States, Europe and South Africa.

Source: ScienceDaily.com

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Biopure Phase III Orthopedic Trial Results Published in Journal of Trauma

Biopure Corporation (Nasdaq: BPUR) today announced that the results from its Phase III orthopedic trial (HEM-115) have been published in the June 2008 issue of the Journal of Trauma. This paper is entitled “HBOC-201 as an Alternative to Blood Transfusion: Efficacy and Safety Evaluation in a Multicenter Phase III Trial in Elective Orthopedic Surgery.”

Source: CNNMoney

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Hemostats, Sealants, and Adhesives: Components of the Surgical Toolbox

The surgical toolbox is expanding, and newer products are being developed to improve results. Reducing blood loss so that bloodless surgery can be performed may help minimize morbidity and length of stay.

Source: SABM

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Blood Storage Impacts Survival Rate

The study findings should urge doctors to be “more conservative with how they approach blood transfusion,” says Dr. Koch. For instance, many patients who are anemic can take iron supplements before surgery to minimize the need for red-blood-cell transfusions.

Source:  Wall Street Journal

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History and Organization of Blood Management

Basics of Blood Management (Blackwell Publishing, September 2007) is the first book dedicated to blood management, a multidisciplinary and multimodality concept that focuses on patient outcome and provides a better and more comprehensive understanding of the new and exciting fields of bloodless medicine and blood management.

The first chapter of this publication highlights the fascinating but often untold history of blood management from the military’s role in blood management down to the involvement of an unlikely group, Jehovah’s Witnesses. The first chapter (sample chapter) is available for download here.

Whether you are an early practising clinician in hematology, transfusion, critical care, anesthesiology, surgery or internal medicine, a nursing specialist, trainee or other member of the multidisciplinary blood management team, this book will answer all your questions about blood management as an aid in improving patient outcome.

Source: Blackwell Publishing

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A Transfusion Alternative?

In many countries the number of eligible blood donors is rapidly shrinking due to the prevalence of infectious diseases (HIV/AIDS, HepC, etc) and the risk of emerging pathogens. Now, a new class of drugs called “oxygen therapeutics” may reduce the need for conventional blood transfusions in surgical patients with acute anemia, a deficiency of red blood cells (RBCs).

Source: Physician’s Weekly

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Wrist Angioplasty Associated with 50% Less Blood Transfusions and Lower Mortality

Although excessive bleeding and blood transfusions after angioplasty have been associated with increased mortality in a number of studies, this Canadian registry analysis, due to its extensive breadth in numbers of patients, is among the first to observe a difference in mortality when comparing the femoral and radial approaches. As the authors state:

“We now present the first data to support the hypothesis that radial access, with a proven lower incidence of access site related bleeding and transfusion, may be associated with a reduction in mortality, independent of other major outcome predictors.

“The principal findings of this study are a reduction in 30 day and 1 year mortality associated with a halving of transfusion rate using trans-radial access instead of femoral in all-comers to PCI. We confirm transfusion-status as an important independent predictor of 1 year mortality and support the suggestion that safety and bleeding concerns should move to the forefront of the PCI agenda.”

Source: TransRadial Access News

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The University Center for Bloodless Surgery and Medicine

The University Center for Bloodless Surgery and Medicine provides the highest quality care to all patients who wish to avoid the use of blood transfusions. A team of physicians, nurses and other health professionals provide care across the full spectrum of services at University Hospital, utilizing the latest bloodless techniques for a wide range of elective and emergency procedures.

The team is committed to the concept of bloodless surgery and medicine and will honor the wishes of patients requesting this type of treatment.

Source: The University Center for Bloodless Surgery and Medicine

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San Antonio’s First Bloodless Hospital

We have learned San Antonio is about to get its first bloodless hospital. That means it will be performing surgeries without giving blood transfusions…

Source: TheNewsRoom

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‘Bloodless surgery’ grant to NorthBay

While bloodless surgery has become more and more of a mainstream practice in recent years, Sharp Chula Vista Medical Center remains the only hospital in the county to offer a bloodless medical program…

Source: San Diego Business Journal Online

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Bloodless Medicine – University of Pennsylvania Health System

Some people elect not to receive blood transfusions or blood products during surgery. This approach is known as “bloodless medicine,” and there are a number of medical and ethical reasons why a patient might make this decision.

Bloodless medicine is an exciting field made possible by a growing number of cutting-edge techniques. Many of these techniques are only available in select medical centers that have the right equipment and clinical staff trained in bloodless methods. If you want to know more, this guide explains how surgeries can be safely performed without blood transfusions or major blood products.

Source:  University of Pennsylvania Health System

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Surgery Without Blood Transfusions

The Feb. 7 Washington in Brief news story “FDA Fines Red Cross $4.6 Million” described government regulators finding improper screening of blood donations. Several times recently, The Post has discussed doctors’ concerns about blood transfusions, among them the numbers of heart attacks and strokes in recipients…

Source: Washington Post

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NYU Med. Center successfully completed first percutaneous endovascular repair

NYU Medical Center performed its first percutaneous endovascular repair in December. A month later and the patient is doing well, according to a hospital press release…

Source: Washington Square News

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“Bloodless Surgery” Avoids Risks of Transfusions

Bloodless surgery techniques vary depending on the type of operation, but can include efficient heart-lung bypass machines that circulate a patient’s blood during surgery; using high-tech scalpels that clot the blood as they cut tissue; or freezing tissue before it’s excised.

Among the benefits are reductions in recovery time, hospital stay, cost and complications — as well as an estimated $20,000 in savings per patient, said Dr. Charles Bridges, the Pennsylvania Hospital cardiologist who performed Shapiro’s surgery.

“There’s no downside to it that we can see, and there’s certainly no downside that’s been documented,” Bridges said.

The trend toward avoiding transfusions is gaining momentum among doctors and patients, said Dr. Patricia Ford, director of Pennsylvania Hospital’s Center for Bloodless Medicine & Surgery. Transfusions are lifesavers during emergencies, but they can be avoided in most elective operations, she said.

Source: MSNBC – Associated Press

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