Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

Federico Coccolini¹, Aryeh Shander², Marco Ceresoli³, Ernest Moore⁴, Brian Tian⁵, Dario Parini⁶, Massimo Sartelli⁷, Boris Sakakushev⁸, Krstina Doklestich⁹, Fikri Abu-Zidan¹⁰, Tal Horer¹¹, Vishal Shelat¹², Timothy Hardcastle¹³, Elena Bignami¹⁴, Andrew Kirkpatrick¹⁵, Dieter Weber¹⁶, Igor Kryvoruchko¹⁷, Ari Leppaniemi¹⁸, Edward Tan¹⁹, Boris Kessel²⁰, Arda Isik²¹, Camilla Cremonini²², Francesco Forfori²³, Lorenzo Ghiadoni²⁴, Massimo Chiarugi²², Chad Ball²⁵, Pablo Ottolino²⁶, Andreas Hecker²⁷, Diego Mariani²⁸, Ettore Melai²³, Manu Malbrain²⁹, Vanessa Agostini³⁰, Mauro Podda³¹, Edoardo Picetti³², Yoram Kluger³³, Sandro Rizoli³⁴, Andrey Litvin³⁵, Ron Maier³⁶, Solomon Gurmu Beka³⁷, Belinda De Simone³⁸, Miklosh Bala³⁹, Aleix Martinez Perez⁴⁰, Carlos Ordonez⁴¹, Zenon Bodnaruk⁴², Yunfeng Cui⁴³, Augusto Perez Calatayud⁴⁴, Nicola de Angelis⁴⁵, Francesco Amico⁴⁶, Emmanouil Pikoulis⁴⁷, Dimitris Damaskos⁴⁸, Raul Coimbra⁴⁹, Mircea Chirica⁵⁰, Walter L Biffl⁵¹, Fausto Catena⁵

Affiliations

¹ General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy. federico.coccolini@gmail.com.
² Anesthesiology and Critical Care, Rutgers University, Newark, NJ, USA.
³ General Emergency and Trauma Surgery Department, Monza University Hospital, Monza, Italy.
⁴ Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, CO, USA.
⁵ General Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy.
⁶ General Surgery Department, Rovigo Hospital, Rovigo, Italy.
⁷ General Surgery Department, Macerata Hospital, Macerata, Italy.
⁸ General Surgery Department, University Hospital St George, Medical University, Plovdiv, Bulgaria.
⁹ Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
¹⁰ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
¹¹ Vascular and Trauma Surgery, Orebro Hospital, Orebro, Sweden.
¹² Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
¹³ Department of Trauma and Burns, Inkosi Albert Luthuli Central Hospital and Department of Surgical Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁴ Anesthesia Department, Parma University Hospital, Parma, Italy.
¹⁵ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, Calgary, AB, Canada.
¹⁶ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
¹⁷ Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine.
¹⁸ General Surgery Department, Melahiti Hospital, Helsinki, Finland.
¹⁹ Emergency Surgery Department, Radboud Medical Centre, Nijmegen, The Netherlands.
²⁰ Hillel Yaffe Medical Center, Rappaport Medical School, Haifa, Israel.
²¹ Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey.
²² General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
²³ ICU Department, Pisa University Hospital, Pisa, Italy.
²⁴ Emergency Medicine Department, Pisa University Hospital, Pisa, Italy.
²⁵ Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada.
²⁶ Unidad de Trauma y Urgencias, Hospital Dr. Sótero del Río, Santiago de Chile, Chile.
²⁷ Department of General, Thoracic and Transplant Surgery, University Hospital of Giessen, Giessen, Germany.
²⁸ General Surgery Department, Legnano Hospital, Legnano, Italy.
²⁹ First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
³⁰ Medicina Trasfusionale, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
³¹ Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³² Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
³³ General, Emergency and Trauma Surgery Department, Rambam Medical Centre, Tel Aviv, Israel.
³⁴ Trauma Surgery, Hamad General Hospital, Doha, Qatar.
³⁵ Department of Surgical Diseases No. 3, University Clinic, Gomel State Medical University, Gomel, Belarus.
³⁶ Harborview Medical Center, University of Washington, Seattle, WA, USA.
³⁷ Emergency Surgery, Ethiopian Air Force, Bishoftu, Ethiopia.
³⁸ Department of Digestive and Emergency Surgery, Infermi Hospital, Rimini, Italy.
³⁹ Trauma and Acute Care Surgery Unit Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel.
⁴⁰ Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain.
⁴¹ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
⁴² Hospital Information Services for Jehovah's Witnesses, Tuxedo Park, NY, USA.
⁴³ Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
⁴⁴ Critical Care Division Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico.
⁴⁵ General Surgery Department, Ferrara University Hospital, Ferrara, Italy.
⁴⁶ Discipline of Surgery, The University of Newcastle, Newcastle, Australia.
⁴⁷ 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
⁴⁸ General Surgery Department, Edinburgh Hospital, Edinburgh, UK.
⁴⁹ General Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA.
⁵⁰ General Surgery Department, Grenoble University Hospital, Grenoble, France.
⁵¹ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.

PMID: 39010099
PMCID: PMC11251377
DOI: 10.1186/s13017-024-00554-7

Review

Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

Federico Coccolini et al. World J Emerg Surg. 2024.

. 2024 Jul 16;19(1):26.

doi: 10.1186/s13017-024-00554-7.

Authors

Affiliations

¹ General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy. federico.coccolini@gmail.com.
² Anesthesiology and Critical Care, Rutgers University, Newark, NJ, USA.
³ General Emergency and Trauma Surgery Department, Monza University Hospital, Monza, Italy.
⁴ Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, CO, USA.
⁵ General Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy.
⁶ General Surgery Department, Rovigo Hospital, Rovigo, Italy.
⁷ General Surgery Department, Macerata Hospital, Macerata, Italy.
⁸ General Surgery Department, University Hospital St George, Medical University, Plovdiv, Bulgaria.
⁹ Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
¹⁰ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
¹¹ Vascular and Trauma Surgery, Orebro Hospital, Orebro, Sweden.
¹² Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
¹³ Department of Trauma and Burns, Inkosi Albert Luthuli Central Hospital and Department of Surgical Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁴ Anesthesia Department, Parma University Hospital, Parma, Italy.
¹⁵ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, Calgary, AB, Canada.
¹⁶ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
¹⁷ Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine.
¹⁸ General Surgery Department, Melahiti Hospital, Helsinki, Finland.
¹⁹ Emergency Surgery Department, Radboud Medical Centre, Nijmegen, The Netherlands.
²⁰ Hillel Yaffe Medical Center, Rappaport Medical School, Haifa, Israel.
²¹ Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey.
²² General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
²³ ICU Department, Pisa University Hospital, Pisa, Italy.
²⁴ Emergency Medicine Department, Pisa University Hospital, Pisa, Italy.
²⁵ Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada.
²⁶ Unidad de Trauma y Urgencias, Hospital Dr. Sótero del Río, Santiago de Chile, Chile.
²⁷ Department of General, Thoracic and Transplant Surgery, University Hospital of Giessen, Giessen, Germany.
²⁸ General Surgery Department, Legnano Hospital, Legnano, Italy.
²⁹ First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
³⁰ Medicina Trasfusionale, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
³¹ Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³² Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
³³ General, Emergency and Trauma Surgery Department, Rambam Medical Centre, Tel Aviv, Israel.
³⁴ Trauma Surgery, Hamad General Hospital, Doha, Qatar.
³⁵ Department of Surgical Diseases No. 3, University Clinic, Gomel State Medical University, Gomel, Belarus.
³⁶ Harborview Medical Center, University of Washington, Seattle, WA, USA.
³⁷ Emergency Surgery, Ethiopian Air Force, Bishoftu, Ethiopia.
³⁸ Department of Digestive and Emergency Surgery, Infermi Hospital, Rimini, Italy.
³⁹ Trauma and Acute Care Surgery Unit Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel.
⁴⁰ Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain.
⁴¹ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
⁴² Hospital Information Services for Jehovah's Witnesses, Tuxedo Park, NY, USA.
⁴³ Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
⁴⁴ Critical Care Division Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico.
⁴⁵ General Surgery Department, Ferrara University Hospital, Ferrara, Italy.
⁴⁶ Discipline of Surgery, The University of Newcastle, Newcastle, Australia.
⁴⁷ 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
⁴⁸ General Surgery Department, Edinburgh Hospital, Edinburgh, UK.
⁴⁹ General Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA.
⁵⁰ General Surgery Department, Grenoble University Hospital, Grenoble, France.
⁵¹ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.

PMID: 39010099
PMCID: PMC11251377
DOI: 10.1186/s13017-024-00554-7

Abstract

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Keywords: Blood management; Jehovah’s witnesses; Management; Morbidity; Mortality; Optimization; Policy; Refusal; Religion.

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Conflict of interest statement

The authors declare no competing interests.

References

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Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

Affiliations

Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical