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

Conclusions/Final Statement

Coagulopathy associated with cardiac surgery and CPB is complex and leads to allogeneic blood transfusions that are associated with a high rate of postoperative complications and mortality. Despite the existence of guidelines and consensus statements regarding perioperative blood management in cardiac surgery patients, practitioner adherence to these guidelines is low and significant variability in practices exists. Current guidelines are lengthy documents and may cause confusion if conflicting recommendations exist. The current summary statement of the SCA Blood Conservation Working Group is an attempt to create a clear and succinct document containing recommendations for perioperative blood management for cardiac surgical patients. Individualized therapy using POC-guided algorithms is recommended because they have been associated with improved patient outcomes when compared to standard laboratory-based or empiric transfusion therapy. The publication of these viscoelastic and nonviscoelastic testing algorithms will hopefully consolidate the existing evidence and provide clinicians with a simple tool that will aid them in managing the bleeding cardiovascular surgery patient.