Methodologic Quality and Pharmacotherapy Recommendations for Patient Blood Management Guidelines for Cardiac Surgery on Cardiopulmonary Bypass

Patient blood management (PBM) guidelines for patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) have been increased during the past decade and pharmacotherapy plays an important role in PBM. In the face of the undefined consistency of the methodological quality and pharmacotherapy recommendations across multiple guidelines, this study exclusively evaluates methodologies of the related guideline development process and compiles medication recommendations of PBM for cardiac surgery patients. PBM guidelines were searched for cardiac surgery under CPB through some mainstream literature and guideline databases from database establishment to May 15, 2023. Nine guidelines meeting inclusion criteria were included in this study. The quality of the guidelines was evaluated by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. "Stakeholder involvement" received the lowest mean score of 49.38% in the AGREE II scoring over the guidelines. PBM for cardiac surgery patients spans the perioperative phase. Drug therapy strategies of PBM for cardiac surgery patients involved anemia therapy, perioperative administration of antithrombotic drugs, intraoperative anticoagulation, and the utilization of hemostatic drugs. Unlike adults, medication evidence about the management of antithrombotic drugs and hemostatic drugs for pediatric cardiac surgery patients is less. Recombinant activated factor VII (rFVIIa) and desmopressin (DDAVP) are not recommended after pediatric cardiac surgery while prothrombin complex concentrate (PCC) could be considered under the situation of clinical trials. As for the controversies regarding the administration of rFVIIa and DDAVP after adult cardiac surgery by different societies, clinicians should exercise their clinical judgment based on individual patient features.