Ranking the effectiveness of autologous blood conservation measures through validated modeling of independent clinical data
Ranking the effectiveness of autologous blood conservation measures through validated modeling of independent clinical data
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DOI：
10.1111/trf.12233
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发表时间：
2013-12-01
期刊：
影响因子：
2.9
通讯作者：
Singbartl, Kai
中科院分区：
文献类型：
--
作者：
Singbartl, Guenter;Held, Anna-Lena;Singbartl, Kai
背景同种异体输血的未来供应面临着几个关键的挑战，需要对现有的替代品进行彻底（重新）评估。荟萃分析表明，自体血液保护（ABC）措施具有显著的潜力，可减少对同种异体输血的需求。然而，现有研究的质量不允许得出明确的结论。在这种情况下，数学建模提供了独特的机会，比较各种ABC措施，并测试不同的变量对疗效和effectiveness.Study Design and MethodsWe的影响进行了广泛的搜索临床ABC研究，重点是急性等容血液稀释（ANH），术中血液回收（IBS），或术前自体存款（PAD）。仅纳入提供最小临床变量集的ABC研究。使用临床验证的数学模型，然后，我们计算最大允许失血量（疗效）和增加红细胞（RBC）质量（有效性）排名three techniques.ResultsWe确定了21个临床ABC研究，包括3926例患者，适合我们的模型。我们的模型表明，IBS与高回收率是最有效的和有效的ABC措施。PAD将显示几乎相似的功效和有效性，只有当足够的时间用于RBC再生并且如果4个PAD单位或更多可用时。我们的模型进一步表明，ANH以及IBS与低回收率是最不有效和有效的alternatives.ConclusionsIBS似乎是最有效和有效的ABC措施。PAD只能在某些情况下减少异体输血的需要。ANH似乎在ABC中不起重要作用。
BackgroundFuture supply with allogeneic blood transfusions faces several crucial challenges that warrant thorough (re-)evaluation of existing alternatives. Meta-analyses have indicated a significant potential for autologous blood conservation (ABC) measures to reduce the need for allogeneic blood transfusions. The quality of currently available studies, however, prohibits definite conclusions. Under these circumstances, mathematical modeling offers unique opportunities to compare various ABC measures and to test the impact of different variables on efficacy and effectiveness.Study Design and MethodsWe performed an extensive search for clinical ABC studies, focusing on acute normovolemic hemodilution (ANH), intraoperative blood salvage (IBS), or preoperative autologous deposit (PAD). Only ABC studies providing a minimum set of clinical variables were included. Using a clinically validated mathematical model, we then calculated maximal allowable blood loss (efficacy) and increase in red blood cell (RBC) mass (effectiveness) to rank the three techniques.ResultsWe identified 21 clinical ABC studies, including 3926 patients, as suitable for our model. Our model shows that IBS with high recovery rates is the most efficacious and effective ABC measure. PAD will reveal nearly similar efficacy and effectiveness, only if sufficient time for RBC regeneration has passed and if 4 PAD units or more are available. Our model further demonstrates that ANH as well as IBS with low recovery rates are the least efficacious and effective alternatives.ConclusionsIBS appears to be the most efficacious and effective ABC measure. PAD can only reduce the need for allogeneic blood transfusions under certain circumstances. ANH does not appear to play an important role in ABC.