Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference

Markus M. Mueller, Hans Van Remoortel, Patrick Meybohm, Kari Aranko, Cécile Aubron, Reinhard Burger, Jeffrey L. Carson, Klaus Cichutek, Emmy De Buck, Dana Devine, Dean Fergusson, Gilles Folléa, Craig French, Kathrine P. Frey, Richard Gammon, Jerrold H. Levy, Michael F. Murphy, Yves Ozier, Katerina Pavenski, Cynthia So-Osman & 6 others Pierre Tiberghien, Jimmy Volmink, Jonathan H. Waters, Erica M. Wood, Erhard Seifried, ICC PBM Frankfurt 2018 Group

Research output: Contribution to journalReview ArticleOtherpeer-review

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

Cite this

Mueller, M. M., Van Remoortel, H., Meybohm, P., Aranko, K., Aubron, C., Burger, R., ... ICC PBM Frankfurt 2018 Group (2019). Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference. JAMA - Journal of the American Medical Association, 321(10), 983-997. https://doi.org/10.1001/jama.2019.0554
Mueller, Markus M. ; Van Remoortel, Hans ; Meybohm, Patrick ; Aranko, Kari ; Aubron, Cécile ; Burger, Reinhard ; Carson, Jeffrey L. ; Cichutek, Klaus ; De Buck, Emmy ; Devine, Dana ; Fergusson, Dean ; Folléa, Gilles ; French, Craig ; Frey, Kathrine P. ; Gammon, Richard ; Levy, Jerrold H. ; Murphy, Michael F. ; Ozier, Yves ; Pavenski, Katerina ; So-Osman, Cynthia ; Tiberghien, Pierre ; Volmink, Jimmy ; Waters, Jonathan H. ; Wood, Erica M. ; Seifried, Erhard ; ICC PBM Frankfurt 2018 Group. / Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference. In: JAMA - Journal of the American Medical Association. 2019 ; Vol. 321, No. 10. pp. 983-997.
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title = "Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference",
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 = "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 {ICC PBM Frankfurt 2018 Group}",
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Mueller, MM, Van Remoortel, H, Meybohm, P, Aranko, K, Aubron, C, Burger, R, Carson, JL, Cichutek, K, De Buck, E, Devine, D, Fergusson, D, Folléa, G, French, C, Frey, KP, Gammon, R, Levy, JH, Murphy, MF, Ozier, Y, Pavenski, K, So-Osman, C, Tiberghien, P, Volmink, J, Waters, JH, Wood, EM, Seifried, E & ICC PBM Frankfurt 2018 Group 2019, 'Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference' JAMA - Journal of the American Medical Association, vol. 321, no. 10, pp. 983-997. https://doi.org/10.1001/jama.2019.0554

Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference. / Mueller, Markus M.; Van Remoortel, Hans; Meybohm, Patrick; Aranko, Kari; Aubron, Cécile; Burger, Reinhard; Carson, Jeffrey L.; Cichutek, Klaus; De Buck, Emmy; Devine, Dana; Fergusson, Dean; Folléa, Gilles; French, Craig; Frey, Kathrine P.; Gammon, Richard; Levy, Jerrold H.; Murphy, Michael F.; Ozier, Yves; Pavenski, Katerina; So-Osman, Cynthia; Tiberghien, Pierre; Volmink, Jimmy; Waters, Jonathan H.; Wood, Erica M.; Seifried, Erhard; 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 journalReview ArticleOtherpeer-review

TY - JOUR

T1 - Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference

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 - ICC PBM Frankfurt 2018 Group

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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DO - 10.1001/jama.2019.0554

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SN - 0098-7484

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