(精编)【体外膜肺ECMO精品课件】 Blood and Immunomodulation--Can we improve clinical outcomes by leukoreduction, washing and shorter red cell storage教学课件.pptVIP

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2018-03-21 发布于天津
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(精编)【体外膜肺ECMO精品课件】 Blood and Immunomodulation--Can we improve clinical outcomes by leukoreduction, washing and shorter red cell storage教学课件.ppt

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Leukoreduction decreases post-operative mortality in cardiac surgery Death rate reduced from 7.8% to 3.5% (van de Watering 1998), and 10.1% to 5.5% (Bilgin 2001) in randomized trials of leukoreduced transfusions Death rate reduced from 5.3% to 3.2% in our implementation trial with LR blood (p= NS) Post-operative infection has a mortality of 8-15% and is the leading cause of multiorgan failure syndromes Misapplication of the intention to treat principle in meta-analyses of LR The published meta-analyses arbitrarily assigned hundreds of non-transfused patients and their infections, in equal numbers, to each arm of the study. These patients had been excluded by the original authors. This rendered the results non-significant in some cases Evidence based medicine cannot consist of adding back to the analysis patients for whom you have no data whatever. Fictional data cannot be used to draw scientific conclusions Transfusion 47: 573-581(2007) Limitations of the Existing Trial of ULR--Transfusion 42:1114 (2002) More than one in eight patients in the LR arm received some non-LR blood (12.6%) Patients in the LR arm were significantly more likely to receive non-LR blood than patients in the non-LR were to receive LR blood (p=0.0055) Transfusion 50: 2738 (December 2010) Transfusion 50: 2738 (December 2010) Proven Benefits of Leukoreduction Reduced febrile transfusion reactions Reduced HLA alloimmunization/reduced platelet refractoriness Reduced CMV transmission Reduced post-operative infections Reduced cardiac surgery mortality Cost Savings with Leukoreduction Cardiac surgery implementation trial (Am J Clin Path 118: 376-381, 2002) Leukoreduction: cost per hospitalization DECREASED $1,700 Non-transfused patients: cost per hospitalization INCREASED $4,000 750,000 cases nationwide x $1,700 = $1.3 billion/year Enough to pay for universal leukoreduction 2-3 times over Estimated deaths potentially averted in surgical patients by leukoreduced transfusions 2 millio