Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial.

Abstract:

OBJECTIVE:To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery. DESIGN:Randomised controlled trial. SETTING:Regional cardiac centre in a teaching hospital in Southampton. PARTICIPANTS:263 adults aged 18-80 years undergoing elective coronary artery bypass surgery entered the study, of whom 252 completed the trial. All patients received routine perioperative care. Patients were allocated to one of three treatment groups: intraoperative cell salvage, intraoperative cell salvage with acute perioperative normovolaemic haemodilution, or no mechanical blood conservation. There were 84 patients in each group. MAIN OUTCOME MEASURES:Numbers of patients who received allogeneic blood or coagulation products, and the mean number of units of blood transfused per patient. RESULTS:Of the patients in the intraoperative cell salvage group, 26 were given a transfusion of allogeneic blood, compared with 43 in the control group (odds ratio 0.43 (95% confidence interval 0.23 to 0.80)). The mean number of units of allogeneic blood transfused per patient in the intraoperative cell salvage group was 0.68 units (SD=1.55), compared with 1.07 (1.56) units in the control group. 32 of the patients in the intraoperative cell salvage group were given any blood product, compared with 47 in the control group (odds ratio 0.47 (0.25 to 0.89); P=0.019). Combining acute perioperative normovolaemic haemodilution with intraoperative cell salvage conferred no additional benefits. CONCLUSIONS:An intraoperative cell salvage device should be used in elective coronary artery bypass grafting. Pharmacological strategies may achieve further reductions in blood transfusions. Yet further reductions in blood transfusions could be achieved if the lower safe limit of haemoglobin concentration in patients undergoing cardiac surgery were known.

journal_name

BMJ

authors

McGill N,O'Shaughnessy D,Pickering R,Herbertson M,Gill R

doi

10.1136/bmj.324.7349.1299

keywords:

subject

Has Abstract

pub_date

2002-06-01 00:00:00

pages

1299

issue

7349

eissn

0959-8138

issn

1756-1833

journal_volume

324

pub_type

临床试验,杂志文章,随机对照试验
  • Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study.

    abstract:OBJECTIVE:To examine associations between varenicline and the incidence of a range of adverse outcomes. DESIGN:Population based cohort study using within person analyses to control for confounding by indication. SETTING:Whole population of Sweden. PARTICIPANTS:7,917,436 people aged 15 and over, of whom 69,757 were t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h2388

    authors: Molero Y,Lichtenstein P,Zetterqvist J,Gumpert CH,Fazel S

    更新日期:2015-06-02 00:00:00

  • Baby food industry lobbies WHO on breast feeding advice.

    abstract::In the existing WHO guidelines, complementary feeding at 4-6 months is advocated. However, many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, subsequently suggesting that the WHO should change its recommendations to about 6 mon...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 新闻

    doi:

    authors: Yamey G

    更新日期:2000-09-09 00:00:00

  • Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial.

    abstract:OBJECTIVE:To determine the effect of four monthly vitamin D supplementation on the rate of fractures in men and women aged 65 years and over living in the community. DESIGN:Randomised double blind controlled trial of 100 000 IU oral vitamin D3 (cholecalciferol) supplementation or matching placebo every four months ove...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.326.7387.469

    authors: Trivedi DP,Doll R,Khaw KT

    更新日期:2003-03-01 00:00:00

  • Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain.

    abstract:OBJECTIVES:To compare patients' preference for transdermal fentanyl or sustained release oral morphine, their level of pain control, and their quality of life after treatment. DESIGN:Randomised, multicentre, international, open label, crossover trial. SETTING:35 centres in Belgium, Canada, Denmark, Finland, the Unite...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.322.7295.1154

    authors: Allan L,Hays H,Jensen NH,de Waroux BL,Bolt M,Donald R,Kalso E

    更新日期:2001-05-12 00:00:00

  • Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial.

    abstract:OBJECTIVE:To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients. DESIGN:Randomised controlled trial. SETTING:Home based intervention in heart failure patients. PARTICIPANTS:293 patie...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.39164.568183.AE

    authors: Holland R,Brooksby I,Lenaghan E,Ashton K,Hay L,Smith R,Shepstone L,Lipp A,Daly C,Howe A,Hall R,Harvey I

    更新日期:2007-05-26 00:00:00

  • Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial.

    abstract:OBJECTIVE:To assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer. DESIGN:Blinded randomized placebo controlled trial. SETTING:Linqu County, Shandong province, China. PARTICIPANTS:3365 residents of a high risk region for gastric ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.l5016

    authors: Li WQ,Zhang JY,Ma JL,Li ZX,Zhang L,Zhang Y,Guo Y,Zhou T,Li JY,Shen L,Liu WD,Han ZX,Blot WJ,Gail MH,Pan KF,You WC

    更新日期:2019-09-11 00:00:00

  • Radiographic examination of the lumbar spine in a community hospital: an audit of current practice.

    abstract:OBJECTIVE:To assess general practitioners' decisions to request lumbar spine radiographs according to the guidelines of the Royal College of Radiologists. DESIGN:Prospective questionnaire survey of outpatients attending for lumbar spine radiography. SETTING:London community hospital. SUBJECTS:100 consecutive adult o...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6806.813

    authors: Halpin SF,Yeoman L,Dundas DD

    更新日期:1991-10-05 00:00:00

  • Integrating undergraduate and postgraduate education in general practice: experience in Tayside.

    abstract::Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for change, national developments in education, financial support through funds se...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.310.6994.1577

    authors: Bain J,Scott R,Snadden D

    更新日期:1995-06-17 00:00:00

  • Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study.

    abstract:OBJECTIVE:To assess predictors of mortality in a population of people prescribed methadone. DESIGN:Retrospective cohort study. SETTING:Geographically defined population in Tayside, Scotland. PARTICIPANTS:2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004. MAIN OUTCOME MEASU...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.b2225

    authors: McCowan C,Kidd B,Fahey T

    更新日期:2009-06-16 00:00:00

  • Optimisation of positive and expiratory pressure for maximal delivery of oxygen to tissues using oesophageal Doppler ultrasonography.

    abstract:OBJECTIVE:To assess oesophageal Doppler ultrasonography as a convenient means of optimising positive end expiratory pressure for maximal delivery of oxygen to tissues. DESIGN:Measurements of blood flow, arterial oxygen saturation, and cardiac output by thermodilution (when available) at baseline and at 20-30 minutes a...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.298.6684.1350

    authors: Singer M,Bennett D

    更新日期:1989-05-20 00:00:00

  • Should fertile people have access to in vitro fertilisation?

    abstract::Some existing laws and some proposed legislation regulating the practice of in vitro fertilization (IVF) limit its availability to infertile couples. Dawson and Singer question whether it is reasonable to so restrict access to IVF, and examine some of the medical and social circumstances in which IVF and the related ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6718.167

    authors: Dawson K,Singer P

    更新日期:1990-01-20 00:00:00

  • Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study.

    abstract:OBJECTIVE:To examine the absolute risks or benefits on cancer associated with oral contraception, using incident data. DESIGN:Inception cohort study. SETTING:Royal College of General Practitioners' oral contraception study. PARTICIPANTS:Directly standardised data from the Royal College of General Practitioners' oral...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.39289.649410.55

    authors: Hannaford PC,Selvaraj S,Elliott AM,Angus V,Iversen L,Lee AJ

    更新日期:2007-09-29 00:00:00

  • Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial.

    abstract:OBJECTIVE:To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. DESIGN:Double blind cluster randomised controlled trial. SETTING:Rural community in south eastern Nepal. PARTICIPANTS:4926 pregnant women and 4130 live born infants. INTER...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.326.7389.571

    authors: Christian P,Khatry SK,Katz J,Pradhan EK,LeClerq SC,Shrestha SR,Adhikari RK,Sommer A,West KP Jr

    更新日期:2003-03-15 00:00:00

  • Robots in operating theatres.

    abstract::Robots designed for surgery have three main advantages over humans. They have greater three dimensional spatial accuracy, are more reliable, and can achieve much greater precision. Although few surgical robots are yet in clinical trials one or two have advanced to the stage of seeking approval from the UK's Medical De...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.311.7018.1479

    authors: Buckingham RA,Buckingham RO

    更新日期:1995-12-02 00:00:00

  • Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

    abstract:OBJECTIVE:To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN:Retrospective data on primary care were collected over a 4.5 year period fro...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.314.7073.38

    authors: Worrall A,Rea JN,Ben-Shlomo Y

    更新日期:1997-01-04 00:00:00

  • Amblyopia treatment outcomes after screening before or at age 3 years: follow up from randomised trial.

    abstract:OBJECTIVE:To assess the effectiveness of early treatment for amblyopia in children. DESIGN:Follow up of outcomes of treatment for amblyopia in a randomised controlled trial comparing intensive orthoptic screening at 8, 12, 18, 25, 31, and 37 months (intensive group) with orthoptic screening at 37 months only (control ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7353.1549

    authors: Williams C,Northstone K,Harrad RA,Sparrow JM,Harvey I,ALSPAC Study Team.

    更新日期:2002-06-29 00:00:00

  • Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies.

    abstract:OBJECTIVE:To investigate the relation between total fat intake and body weight in adults and children. DESIGN:Systematic review and meta-analysis of randomised controlled trials and cohort studies. DATA SOURCES:Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials to June 2010. INCLUSION CR...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.e7666

    authors: Hooper L,Abdelhamid A,Moore HJ,Douthwaite W,Skeaff CM,Summerbell CD

    更新日期:2012-12-06 00:00:00

  • Hormone replacement therapy and risk of venous thromboembolism: population based case-control study.

    abstract:OBJECTIVE:To evaluate the association between use of hormone replacement therapy and the risk of idiopathic venous thromboembolism. DESIGN:Population based case-control study. SETTING:Population enrolled in the General Practice Research Database, United Kingdom. SUBJECTS:A cohort of 347,253 women aged 50 to 79 witho...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.314.7083.796

    authors: Pérez Gutthann S,García Rodríguez LA,Castellsague J,Duque Oliart A

    更新日期:1997-03-15 00:00:00

  • Statin use and risk of community acquired pneumonia in older people: population based case-control study.

    abstract:OBJECTIVE:To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia. DESIGN:Population based case-control study. SETTING:Group Health, a large integrated healthcare delivery system. Population Immunocompetent, community dwelling ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.b2137

    authors: Dublin S,Jackson ML,Nelson JC,Weiss NS,Larson EB,Jackson LA

    更新日期:2009-06-16 00:00:00

  • Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales.

    abstract:OBJECTIVE:To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions. DESIGN:National survey of 25% random sample of community (high street) pharmacies through postal questionnaire, with four mailin...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7052.270

    authors: Strang J,Sheridan J,Barber N

    更新日期:1996-08-03 00:00:00

  • Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial).

    abstract:OBJECTIVE:To investigate the effectiveness of supplementing information and advice on analgesia and exercise from a general practitioner with transcutaneous electrical nerve stimulation (TENS) as a non-drug form of analgesia to reduce pain intensity in patients with tennis elbow. DESIGN:Pragmatic randomised controlled...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.f5160

    authors: Chesterton LS,Lewis AM,Sim J,Mallen CD,Mason EE,Hay EM,van der Windt DA

    更新日期:2013-09-02 00:00:00

  • Cardiac rehabilitation for heart failure can improve quality of life and fitness.

    abstract::The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 评论,杂志文章

    doi:10.1136/bmj.l5456

    authors: Cook R,Davidson P,Martin R,NIHR Dissemination Centre.

    更新日期:2019-10-01 00:00:00

  • Twins and maternal smoking: ordeals for the fetal origins hypothesis? A cohort study.

    abstract:OBJECTIVE:To assess the direct and indirect effects of being a twin, maternal smoking, birth weight, and mother's height on blood pressure at ages 9 and 18 years. DESIGN:Longitudinal study. SUBJECTS:Cohort born in 1972-3. SETTING:Dunedin, New Zealand. MAIN OUTCOME MEASURE:Blood pressure at ages 9 and 18 years. RES...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.318.7188.897

    authors: Williams S,Poulton R

    更新日期:1999-04-03 00:00:00

  • International variation in radiation dose for computed tomography examinations: prospective cohort study.

    abstract:OBJECTIVE:To determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT). DESIGN:Prospective cohort study. SETTING:Data were assembled and analyzed from the University of California San Francisco CT International Dose Registry. PARTICI...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.k4931

    authors: Smith-Bindman R,Wang Y,Chu P,Chung R,Einstein AJ,Balcombe J,Cocker M,Das M,Delman BN,Flynn M,Gould R,Lee RK,Yellen-Nelson T,Schindera S,Seibert A,Starkey J,Suntharalingam S,Wetter A,Wildberger JE,Miglioretti DL

    更新日期:2019-01-02 00:00:00

  • Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial.

    abstract:OBJECTIVE:To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. DESIGN:Cluster randomised controlled trial over 20 weeks. SETTING:Family compou...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38512.618681.E0

    authors: Crump JA,Otieno PO,Slutsker L,Keswick BH,Rosen DH,Hoekstra RM,Vulule JM,Luby SP

    更新日期:2005-09-03 00:00:00

  • Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials.

    abstract:OBJECTIVE:To compare the effectiveness of elective single embryo transfer versus double embryo transfer on the outcomes of live birth, multiple live birth, miscarriage, preterm birth, term singleton birth, and low birth weight after fresh embryo transfer, and on the outcomes of cumulative live birth and multiple live b...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.c6945

    authors: McLernon DJ,Harrild K,Bergh C,Davies MJ,de Neubourg D,Dumoulin JC,Gerris J,Kremer JA,Martikainen H,Mol BW,Norman RJ,Thurin-Kjellberg A,Tiitinen A,van Montfoort AP,van Peperstraten AM,Van Royen E,Bhattacharya S

    更新日期:2010-12-21 00:00:00

  • Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis.

    abstract:OBJECTIVES:To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. DESIGN:Randomised c...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38558.393669.E0

    authors: McManus RJ,Mant J,Roalfe A,Oakes RA,Bryan S,Pattison HM,Hobbs FD

    更新日期:2005-09-03 00:00:00

  • Injuries from antipersonnel mines: the experience of the International Committee of the Red Cross.

    abstract:OBJECTIVE:To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN:Retrospective analysis. SETTING:Two hospitals for patients injured in war. SUBJECTS:757 patients with injuries from antipersonnel mines. MAI...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6816.1509

    authors: Coupland RM,Korver A

    更新日期:1991-12-14 00:00:00

  • Research priorities in environmental health.

    abstract::Environmental issues tend to greater political attention than do environmental health aspects. Therefore, when conflicts of interest occur with other environmental concerns, negative consequences for public health may result. For example, a strategy to substantially reduce indoor ventilation in many dwellings in Sca...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 社论

    doi:10.1136/bmj.318.7199.1636

    authors: Pershagen G

    更新日期:1999-06-19 00:00:00

  • Prospective randomised study of an orthopaedic geriatric inpatient service.

    abstract::A randomised controlled trial of two management regimens was carried out in women patients over 65 years of age with hip fractures. Ninety seven patients were admitted to a designated orthopaedic geriatric unit and 125 to orthopaedic wards. No difference was observed in mortality, length of stay, or placement of patie...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.297.6656.1116

    authors: Gilchrist WJ,Newman RJ,Hamblen DL,Williams BO

    更新日期:1988-10-29 00:00:00