Masimo Says New Study Shows Noninvasive, Continuous Total Hemoglobin Monitoring Significantly Reduces Blood Transfusions in High Blood Loss Surgery

Noninvasive and continuous total hemoglobin (SpHb) monitoring technology from Masimo

helps clinicians reduce intra-operative red blood cell (RBC) transfusions during high blood-loss surgery, speeds time to transfusion when indicated, and saves significant costs, according to a new study unveiled at the Society for Technology in Anesthesia (STA) annual meeting.1 The study was one of just five receiving the distinguished 2013 award for the best research at the STA meeting. RBC transfusion is one of the most frequent procedures performed in U.S. hospitals, with one in ten inpatients receiving one or more blood units.2 While blood loss during surgery is a known risk factor, RBC transfusion overuse can increase patient risk and cost of care. Meta-analysis of pooled results from multiple observational studies, each of which adjusts for risks between patients, shows patients receiving RBC transfusions have an 88% higher mortality, 69% higher infection rate, and 250% higher rate of ARDS.3 While some clinicians are concerned with the idea of withholding RBC transfusions, multiple randomized controlled trials indicate that restrictive transfusion practices – those in which significantly lower hemoglobin triggers are used to determine need for transfusion – are safe.4 In addition, the cost of each RBC unit is estimated between $522 and $1,183 per unit, without including morbidity-associated costs.5 Hemoglobin levels are used as a primary indicator for RBC transfusion, but laboratory measurements are only available intermittently and results can be delayed in the period between blood draw and laboratory analysis. This time gap of information can lead to sub-optimal transfusion decisions.6 Given the risks and costs of RBC transfusions, there is a growing recognition of the need to implement strategies to reduce transfusions. The American Medical Association and The Joint Commission recently identified RBC transfusions as one of the top five overused procedures in medicine,7 and The Joint Commission has introduced Patient Blood Management Measures that encourage hospitals to evaluate appropriateness of transfusions as a continuous quality indicator.8 A previous study conducted at Massachusetts General Hospital during orthopedic surgery (a low blood loss setting) showed that SpHb monitoring helped clinicians reduce RBC transfusion frequency (from 4.5% to 0.6% of patients, an 87% reduction) and average RBC units per patient (from 0.10 to 0.01 units per patient, a 90% reduction),9 but the current study is the first to report the impact of SpHb in high blood loss surgery.