Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Jacob Raphael, MD; C. David Mazer, MD; Sudhakar Subramani, MD; Andrew Schroeder, MD; Mohamed Abdalla, MD; Renata Ferreira, MD; Philip E. Roman, MD; Nichlesh Patel, MD; Ian Welsby, MBBS; Philip E. Greilich, MD; Reed Harvey, MD; Marco Ranucci, MD; Lori B. Heller, MD; Christa Boer, MD; Andrew Wilkey, MD; Steven E. Hill, MD; Gregory A. Nuttall, MD; Raja R. Palvadi, MD; Prakash A. Patel, MD; Barbara Wilkey, MD; Brantley Gaitan, MD; Shanna S. Hill, MD; Jenny Kwak, MD; John Klick, MD; Bruce A. Bollen, MD; Linda Shore-Lesserson, MD; James Abernathy, MD; Nanette Schwann, MD; W. Travis Lau, MD


Anesth Analg. 2019;129(5):1209-1221. 

In This Article


Working Group

The SCA Blood Conservation Working Group includes appointed members from the United States and internationally. Efforts were made to select members who are experts in patient blood management both from private and academic cardiac anesthesia practices as well as representatives from international cardiac anesthesiology societies. The working group developed the current recommendations after reviewing existing guidelines and consensus statements as well as original published research studies from peer-reviewed journals. In addition, expert opinion about the recommendations was solicited from the task force members. All available information was used to build consensus within the working group to finalize the recommendations.

Search Strategy and Identification of Guidelines

The following databases were searched for relevant clinical studies from inception until October 30, 2018: MEDLINE (Ovid), EMBASE (, PUBMED (NCBI), the Cochrane Central Register of controlled Trials (CENTRAL), BIOSIS (Web of Science), and Google Scholar. The search was not limited by date or publication status, but was restricted to articles that were only published in English. In addition, we also searched the reference lists of relevant reviews, available online conference proceedings, and published practice guidelines and their respective reference lists. Inclusion criteria included randomized controlled trials (RCTs), meta-analyses, large-scale observational studies, and practice guidelines of patients undergoing cardiovascular surgical procedures with or without cardiopulmonary bypass (CPB). Reviewers independently screened citations to select publications that met inclusion criteria. Studies were not blinded to author, journal, or institution. The specific search terms that were used in obtaining relevant publications are detailed in Supplemental Digital Content 1, Appendix 1,

Agreement (defined as consensus of ≥75% of the members of the working group on a specific topic) was reached through conference calls and face-to-face meetings. When no agreement could be obtained, or in cases that guidelines papers lacked or differed in recommendations, a consensus was reached following a modified Delphi process.[44] Members who were unable to attend a face-to-face meeting voted via email. Three Delphi cycles were required to reach a consensus, and a final decision was made through a series of teleconference calls and electronic communications. In the absence of published evidence or cutoff values for transfusion triggers, expert consensus statements, based on the most updated published literature, were made to cover specific issues that are essential to daily practice. The level of evidence and the strength of the recommendations (when available) are reported as well (Supplemental Digital Content 2, Table 1,