Patient Blood Management

Recommendations from the 2018 Frankfurt Consensus Conference

ICC PBM Frankfurt 2018 Group

Research output: Contribution to journalArticle

Abstract

Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

Original languageEnglish (US)
Pages (from-to)983-997
Number of pages15
JournalJAMA - Journal of the American Medical Association
Volume321
Issue number10
DOIs
StatePublished - Mar 12 2019

Fingerprint

Erythrocyte Transfusion
Anemia
Research
Hemoglobins
Libraries
Population
Patient Advocacy
Critical Care
Septic Shock
Critical Illness
MEDLINE
Blood Transfusion
Thoracic Surgery
Multicenter Studies
Cost-Benefit Analysis
Observational Studies
Germany
Meta-Analysis
Randomized Controlled Trials
Erythrocytes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Patient Blood Management : Recommendations from the 2018 Frankfurt Consensus Conference. / ICC PBM Frankfurt 2018 Group.

In: JAMA - Journal of the American Medical Association, Vol. 321, No. 10, 12.03.2019, p. 983-997.

Research output: Contribution to journalArticle

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abstract = "Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.",
author = "{ICC PBM Frankfurt 2018 Group} and Mueller, {Markus M.} and {Van Remoortel}, Hans and Patrick Meybohm and Kari Aranko and C{\'e}cile Aubron and Reinhard Burger and Carson, {Jeffrey L.} and Klaus Cichutek and {De Buck}, Emmy and Dana Devine and Dean Fergusson and Gilles Foll{\'e}a and Craig French and Frey, {Kathrine P.} and Richard Gammon and Levy, {Jerrold H.} and Murphy, {Michael F.} and Yves Ozier and Katerina Pavenski and Cynthia So-Osman and Pierre Tiberghien and Jimmy Volmink and Waters, {Jonathan H.} and Wood, {Erica M.} and Erhard Seifried and Pierre Albaladejo and Shubha Allard and Christian Gabriel and Andreas Greinacher and {Van Kraaij}, Marian and Giancarlo Liumbruno and Ben Saxon and Nadine Shehata and Claudio Velati and Danielle Bischof and Jennifer Hamilton and Sigismond Lasocki and Gomez, {Manuel Mũoz} and Thomas Schmitz-Rixen and Hubert Serve and Amanda Thomson and Erik Beckers and Kaaron Benson and Nicole Juffermans and Dawn Maze and Mirski, {Marek A} and Gavin Murphy and Ries, {Jean Jacques} and Tim Walsh and Frank, {Steven Mark}",
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T2 - Recommendations from the 2018 Frankfurt Consensus Conference

AU - ICC PBM Frankfurt 2018 Group

AU - Mueller, Markus M.

AU - Van Remoortel, Hans

AU - Meybohm, Patrick

AU - Aranko, Kari

AU - Aubron, Cécile

AU - Burger, Reinhard

AU - Carson, Jeffrey L.

AU - Cichutek, Klaus

AU - De Buck, Emmy

AU - Devine, Dana

AU - Fergusson, Dean

AU - Folléa, Gilles

AU - French, Craig

AU - Frey, Kathrine P.

AU - Gammon, Richard

AU - Levy, Jerrold H.

AU - Murphy, Michael F.

AU - Ozier, Yves

AU - Pavenski, Katerina

AU - So-Osman, Cynthia

AU - Tiberghien, Pierre

AU - Volmink, Jimmy

AU - Waters, Jonathan H.

AU - Wood, Erica M.

AU - Seifried, Erhard

AU - Albaladejo, Pierre

AU - Allard, Shubha

AU - Gabriel, Christian

AU - Greinacher, Andreas

AU - Van Kraaij, Marian

AU - Liumbruno, Giancarlo

AU - Saxon, Ben

AU - Shehata, Nadine

AU - Velati, Claudio

AU - Bischof, Danielle

AU - Hamilton, Jennifer

AU - Lasocki, Sigismond

AU - Gomez, Manuel Mũoz

AU - Schmitz-Rixen, Thomas

AU - Serve, Hubert

AU - Thomson, Amanda

AU - Beckers, Erik

AU - Benson, Kaaron

AU - Juffermans, Nicole

AU - Maze, Dawn

AU - Mirski, Marek A

AU - Murphy, Gavin

AU - Ries, Jean Jacques

AU - Walsh, Tim

AU - Frank, Steven Mark

PY - 2019/3/12

Y1 - 2019/3/12

N2 - Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

AB - Importance: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. Objective: To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. Evidence Review: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. Findings: From 17607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. Conclusions and Relevance: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

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