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Patient Autonomy and Outcome: Jehovah's Witnesses and Cardiac Surgery [Editorial]
Perelman, Seth I
PMID: 37217421
ISSN: 1532-8422
CID: 5508292
Improving Patient Blood Management Programs: An Implementation Science Approach
Ozawa, Sherri; Ozawa-Morriello, Joshua; Perelman, Seth; Thorpe, Elora; Rock, Rebecca; Pearse, Bronwyn L
Organized patient blood management (PBM) programs function in numerous hospitals and health systems around the world contributing to improved patient outcomes as well as increased patient engagement, decreased resource use, and reductions in health care costs. PBM "programming" ranges from the implementation of single strategies/initiatives to comprehensive programs led by dedicated clinicians and PBM committees, employing the use of multiple PBM strategies. Frontline health care professionals play an important role in leading, implementing, operationalizing, measuring, and sustaining successful PBM programs. In this article, we provide practical implementation guidance to support key clinical, administrative, leadership, and structural elements required for the safe and comprehensive delivery of care in PBM programs at the local level.
PMID: 36638516
ISSN: 1526-7598
CID: 5410532
Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study
Grazioli, Alison; Plazak, Michael; Dahi, Siamak; Rabin, Joseph; Menne, Ashley; Ghoreishi, Mehrdad; Taylor, Bradley; Perelman, Seth; Mazzeffi, Michael
INTRODUCTION/BACKGROUND:It remains unclear whether patients who will not accept allogeneic blood transfusion can be managed successfully with veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO). The objective of our study was to determine what percentage of V-A ECMO patients were managed without allogeneic blood transfusion. METHODS:This was a retrospective, observational cohort study of patients with cardiogenic shock requiring V-A ECMO between January 2016 and January 2019. The primary outcome was avoidance of any allogeneic blood transfusion. RESULTS:< 0.001). CONCLUSIONS:Select patients can be successfully managed on V-A ECMO without allogeneic blood transfusion. Jehovah's Witnesses and other patients with objections to allogeneic transfusion might be offered V-A ECMO if its anticipated duration is short (e.g. <7 days) and baseline hemoglobin concentration is high (e.g. ≥10 mg/dL).
PMID: 35957550
ISSN: 1477-111x
CID: 5287282
Preoperative anemia management in the coronavirus disease (COVID-19) era [Editorial]
Perelman, Seth I; Shander, Aryeh; Mabry, Christian; Ferraris, Victor A
PMCID:7836783
PMID: 34173552
ISSN: 2666-2736
CID: 4925952
Left Atrial Appendage Thrombus Formation after Perioperative Cardioversion in the Setting of Severe Rheumatic Mitral Stenosis
Gorbaty, Benjamin J; Perelman, Seth; Applebaum, Robert M
PMID: 32482503
ISSN: 1532-8422
CID: 4468722
When Blood Is Not an Option: Care of the Jehovah’s Witness Patient
Chapter by: Feit, Justin B; Perelman, Seth
in: Essentials of Blood Product Management in Anesthesia Practice by Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah (Eds)
Cham : Springer International Publishing AG, 2021
pp. 135-140
ISBN: 3030592952
CID: 4836872
Essentials of Blood Product Management in Anesthesia Practice
Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah
Cham : Springer International Publishing AG, 2021
Extent: 469 p.
ISBN: 3030592952
CID: 4832062
Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations
Shander, Aryeh; Brown, James; Licker, Marc; Mazer, David C; Meier, Jens; Ozawa, Sherri; Tibi, Pierre R; Van der Linden, Phillipe; Perelman, Seth
OBJECTIVE:To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). DESIGN/METHODS:A 2-round modified RAND-Delphi consensus process. PARTICIPANTS/METHODS:Seven physicians from multiple geographic locations and clinical disciplines including anesthesiology and cardiac surgery and 1 cardiac surgery perfusionist participated in the survey. One registered nurse, specializing in Patient Blood Management, participated in the discussion but did not participate in the survey. METHODS:A modified RAND-Delphi method was utilized that integrated evidence review with a face-to-face expert multidisciplinary panel meeting, followed by repeated scoring using a 9-point Likert scale. Consensus was determined as a result from the second round survey, as follows: median rating of 1-3: ANH acceptable; median rating of 7-9: ANH not acceptable; median rating of 4-6: use clinical judgment. RESULTS:Evidentiary review identified 18 key peer-reviewed manuscripts for discussion. Through the consensus-building process, 39 statements including 26 contraindications to ANH and 10 CPB patient variables were assessed. In total, 22 statements were accepted or modified for the second scoring round. CONCLUSIONS:Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.
PMID: 32127266
ISSN: 1532-8422
CID: 4340622
Perioperative Anemia: Prevention, Diagnosis, and Management Throughout the Spectrum of Perioperative Care
Warner, Matthew A; Shore-Lesserson, Linda; Shander, Aryeh; Patel, Sephalie Y; Perelman, Seth I; Guinn, Nicole R
Anemia is common in the perioperative period and is associated with poor patient outcomes. Remarkably, anemia is frequently ignored until hemoglobin levels drop low enough to warrant a red blood cell transfusion. This simplified transfusion-based approach has unfortunately shifted clinical focus away from strategies to adequately prevent, diagnose, and treat anemia through direct management of the underlying cause(s). While recommendations have been published for the treatment of anemia before elective surgery, information regarding the design and implementation of evidence-based anemia management strategies is sparse. Moreover, anemia is not solely a concern of the preoperative encounter. Rather, anemia must be actively addressed throughout the perioperative spectrum of patient care. This article provides practical information regarding the implementation of anemia management strategies in surgical patients throughout the perioperative period. This includes evidence-based recommendations for the prevention, diagnosis, and treatment of anemia, including the utility of iron supplementation and erythropoiesis-stimulating agents (ESAs).
PMID: 32167979
ISSN: 1526-7598
CID: 4349922
Implementation of a Preoperative Anemia Clinic Utilizing a Minimal Staffing Model
Mabry, Christian; Perelman, Seth; Kim, Jung T; Blitz, Jeanna D
We present a process map for the implementation of a program to treat preoperative anemia utilizing 1 existing anesthesiologist in the preoperative evaluation clinic. In the first 7 months postimplementation, 342 patients were screened for anemia, 166 were diagnosed, and 107 were treated. The mean increase in hemoglobin in treated patients was ~2 g/dL (range 0-4.9 g/dL). Two patients' surgeries were delayed in favor of treatment and 3 surgical patients, who had received 2 complete iron infusions, received an intraoperative transfusion. The total revenue generated for the institution was enough to subsidize the cost of an additional anesthesiologist.
PMID: 31770131
ISSN: 2575-3126
CID: 4215882