TY - JOUR
T1 - Patient Blood Management
T2 - Recommendations from the 2018 Frankfurt Consensus Conference
AU - Mueller, Markus M.
AU - Van Remoortel, Hans
AU - Meybohm, Patrick
AU - Aranko, Kari
AU - Aubron, Cécile
AU - Burger, Reinhard
AU - Carson, Jeffrey L.
AU - Cichutek, Klaus
AU - De Buck, Emmy
AU - Devine, Dana
AU - Fergusson, Dean
AU - Folléa, Gilles
AU - French, Craig
AU - Frey, Kathrine P.
AU - Gammon, Richard
AU - Levy, Jerrold H.
AU - Murphy, Michael F.
AU - Ozier, Yves
AU - Pavenski, Katerina
AU - So-Osman, Cynthia
AU - Tiberghien, Pierre
AU - Volmink, Jimmy
AU - Waters, Jonathan H.
AU - Wood, Erica M.
AU - Seifried, Erhard
AU - Albaladejo, Pierre
AU - Allard, Shubha
AU - Gabriel, Christian
AU - Greinacher, Andreas
AU - Van Kraaij, Marian
AU - Liumbruno, Giancarlo
AU - Saxon, Ben
AU - Shehata, Nadine
AU - Velati, Claudio
AU - Bischof, Danielle
AU - Hamilton, Jennifer
AU - Lasocki, Sigismond
AU - Gomez, Manuel Muoz
AU - Schmitz-Rixen, Thomas
AU - Serve, Hubert
AU - Thomson, Amanda
AU - Beckers, Erik
AU - Benson, Kaaron
AU - Juffermans, Nicole
AU - Maze, Dawn
AU - Mirski, Marek
AU - Murphy, Gavin
AU - Ries, Jean Jacques
AU - Walsh, Tim
AU - Anthony, Lauren
AU - ICC PBM Frankfurt 2018 Group
N1 - Funding Information:
and Hemanext outside the submitted work. Dr French reported receiving nonfinancial support from National Blood Authority Australia during the conduct of the study; receiving grants and nonfinancial support from National Blood Authority outside the submitted work; and that he is a member of the Medical Advisory Committee, Australian Red Cross Blood Service. Dr Frey reported receiving personal fees from the Patient Readiness Institute outside the submitted work and holding a patent for methods and devices for reducing transfusions during or after surgery and for improving quality of life and function in chronic disease. Dr Levy reported receiving other from Boehringer Ingelheim, CSL Behring, Octapharma, and Instrumentation Labs outside the submitted work. Dr Pavenski reported receiving grants from Ortho Clinical Diagnostics outside the submitted work; serving as medical director of her hospital's patient blood management program; and that she is a member of the National Advisory Committee on Blood and Blood Products (Canada) and member of the steering committee of the ONTraC Program, which is the provincial patient blood management program in Ontario. Dr So-Osman reported receiving a research fee for serving as a member of an expert group on perioperative anemia from Pharmacosmos, outside the submitted work. Dr Waters reported receiving grants and personal fees from Haemonetics and LivaNova outside the submitted work. Dr Wood reported receiving grants from Celgene Corporation, CSL Behring, Australian Red Cross Blood Service, New Zealand Blood Service, Amgen, Abbvie, Bristol-Myers Squibb, Janssen, Roche, Sanofi, and Takeda outside the submitted work. Dr Seifried reported receiving grants from the European Blood Alliance (EBA), American Association of Blood Banks (AABB), International Society of Blood Transfusion (ISBT), Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI), Societe Francaise de Transfusion Sanguine (SFTS), and Societea Italiana di Medicina Transfusionale e Immunoematologia (SIMTI) during the conduct of the study and receiving personal fees from Vivor outside the submitted work. No other authors reported disclosures.
Funding Information:
reported receiving grants from the European Blood Alliance (EBA), American Association of Blood Banks (AABB), International Society of Blood Transfusion (ISBT), Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI), Societe Francaise de Transfusion Sanguine (SFTS), and Societa Italiana di Medicina Trasfusionale e Immunoematologia (SIMTI) during the conduct of the study and receiving personal fees from TerumoBCT outside the submitted work. Dr Van Remoortel reported receiving financial support/funding to his institution from organizers of the ICC-PBM 2018 (see list of cosponsors listed for Dr Mueller above) during the conduct of the study. Dr Meybohm reported receiving grants, personal fees, and nonfinancial support from B. Braun Melsungen, CSL Behring, Fresenius Kabi, and Vifor Pharma; receiving personal fees from Pharmacosmos outside the submitted work; and receiving research grants from the German Research Foundation (ME 3559/1-1, ME 3559/3-1), International Anesthesia Research Society, German Society of Anaesthesiology and Intensive Care Medicine, and European Society of Anaesthesiology. Dr Carson reported serving as the study chair and prinicipal investigator of the MINT trial, which is supported by a grant from US National Heart Lung and Blood Institutes to conduct a clinical trial evaluating red blood cell transfusion thresholds in patients with acute myocardial infarction. Dr De Buck reported receiving financial support/funding to her institution from organizers of the ICC-PBM 2018 (see list of cosponsors listed for Dr Mueller above) during the conduct of the study. Dr Devine reported receiving grants from Macopharma, TerumoBCT,
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/3/12
Y1 - 2019/3/12
N2 - Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
AB - Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
U2 - 10.1001/jama.2019.0554
DO - 10.1001/jama.2019.0554
M3 - (Systematic) Review article
SN - 0098-7484
VL - 321
SP - 983
EP - 997
JO - JAMA-Journal of the American Medical Association
JF - JAMA-Journal of the American Medical Association
IS - 10
ER -