NoBlood:1 - Blood:0
by TheOldHippie 10 Replies latest watchtower medical
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Earnest
Thanks, OldHippie. Good to see you still around.
A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at [Cleveland Clinic] from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did...Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival.
PRINCIPAL FINDINGS
In a large cohort of Witnesses undergoing cardiac surgery, Witnesses had fewer in-hospital complications and better early and similar late survival compared with a matched group of cardiac surgical patients who received RBC transfusions.
In our unadjusted comparisons, we found that Witnesses were at lower risk for adverse postoperative outcomes. Propensity-matched comparisons between Witnesses and patients who received transfusions yielded lower risks for selected postoperative outcomes in Witnesses. Witnesses had fewer postoperative myocardial infarctions, fewer episodes of postoperative ventilator support beyond 24 hours, fewer additional operations for bleeding, shorter intensive care unit and postoperative lengths of stay, and a lower hazard for in-hospital death.
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Diest
I do think a no blood policy makes doctors and think about what they are doing and how they will do it. This leads to a safer surgery.
On the other hand, ask people with sickle cell or lukemia how a no blood policy worked for them.....
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SixofNine
Oops. Blood for the life-saving win. Over, and over, and over again.
From: http://www.sassit.co.za/Journals/Vascular/Vasc%20surg%20on%20the%20modern%20battlefield.pdf
As experience with these injuries has evolved, so has the philosophy on
the bene?ts of early rapid infusion of blood products, high plasma ratios,
Fig. 1. Prehospital hemorrhage control is optimized with an Israeli dressing and two tourniquets (A) for a soldier who had deep cavitary fragment wounds of the lower extremities and
transected femoral artery (B). The SOF Tactical Tourniquet is shown more inferiorly with
the aluminum windless.
1196 FOX & STARNESrecombinant VIIa, and minimal crystalloid use in trauma
[26,27,29,30,35,37]. This new way of thinking known as damage control resuscitation (DCR) is a necessary concept when considering simultaneous
limb salvage e?orts in combat casualties and should be combined with other
traditional damage control maneuvers. In essence this practice serves to customize a vascular surgical plan based on the wounds, physiologic condition,
and response to resuscitation e?orts.
During the spring of 2006, the 10th
Combat Support Hospital, located in
Baghdad, Iraq, embraced the concept of DCR, and the early experience with
this strategy has been recently reported [54]. The general guidelines called
for early transfusion of blood products, warmed and infused rapidly,
when the patients arrived in the admitting area (Fig. 2). An emergency release consisted of 4 units of type O PRBCs and 4 units of AB plasma, but
could include fresh whole blood if the situation dictated. The 1:1 ratio of
fresh frozen plasma (FFP) to red blood cell units, was intentionally high,
and this has been recently shown to reduce mortality [27].Three vials of
rFVIIa (2.4 mg 3) were typically given in the emergency department
(ED), operating room (OR), and intensive care unit (ICU). The goal of these
interventions was a normal INR. In particular, crystalloid ?uids were kept
to an absolute minimum to avoid further iatrogenic physiologic derangement [26]. Heparin was not used in all cases and was often limited to a locally
injected half dose when used. For isolated extremity trauma, rFVIIa was
used sparingly and reserved for cases in which hemorrhage was not surgically treatable or controlled with hemostatic dressings. Trometamol; tris-hydroxymethyl aminomethane (THAM) is a biologically inert amino alcohol of low toxicity that bu?ers carbon dioxide and acids in vitro and in
vivo. In trauma, THAM is a potent and e?ective bu?ering agent that can
be used to counter the coagulopathic e?ects of a progressive lactic acidosis
[55,56]. THAM was routinely given when the admission base de?cit was less
than 10 or a massive transfusion was required. Calcium chloride was also
supplemented based on transfusion requirements and ionized calcium levels
that were obtained frequently and treated accordingly.
Based on this experience, the authors continue to advocate for the early
implementation of blood products, with equal ratios of plasma to packed
cells, fresh whole blood, selective use of rFVIIa, and minimal crystalloid
use when planning for vascular reconstructions in severely injured casualties. These principles represent an evolution in current traditional damage
control philosophy in which amputation was previously favored over elaborate vascular surgery. Modern advancements in DCR during this con?ict
may have expanded the opportunity for battle?eld surgeons to provide de-
?nitive procedures at the initial operative setting.
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Earnest
SixofNine, the 2007 article to which you refer is specifically dealing with vascular trauma surgery on the battlefield and not with cardiac surgery in a modern hospital where there is time and opportunity for best practice.
Further, the opinions voiced in the article are "the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense".
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SixofNine
SixofNine , the 2007 article to which you refer is specifically dealing with vascular trauma surgery on the battlefield and not with cardiac surgery in a modern hospital where there is time and opportunity for best practice.
Uhm, yeah, that is very true and rather self-evident. We can learn a lot from vascular trauma surgery on the battlefield. One thing we learn is that blood saves lives on the battlefield - Just as it does in emergency rooms everywhere.
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MrFreeze
Of course in some procedures, no blood will work better. Wouldn't bet the same if you lose a lot of blood in a car accident though.
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Heaven
Of course in some procedures, no blood will work better. Wouldn't bet the same if you lose a lot of blood in a car accident though.
Yep. My cousin lost that bet years ago.
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GLTirebiter
A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery
Was this a valid sample, or unintentionally self-selected cases not comparable to the population at large? Are the Witness cases generally a lower risk group?
Besides being non-smokers and typically employed in lower stress occupations (thus lower cardiac risk in the first place), would the Witnesses who know they are high risk cases (because of anemia, advanced age, general ill health, more radical surgery required, etc.) avoid surgery altogether, because they know they must not have a transfusion if things went wrong?
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Farkel
Hi, Old Hippie,
Haven't seen you post in ages.
Regarding the title to your thread: let's say that thousands and thousands of JWs died because and simply because they refused blood. Let us say that thousands and thousands of JWs did not die because they refused blood, but ONLY because if they had taken blood, it or curcumstances because of it would have killed them.
Now, if only ONE JW more did not die because they received blood, then it would be Blood: 1 No Blood: 0.
As slim as they are, the odds are still in favor of taking blood when deemed necessary.
If there were more "worldly" people dying BECAUSE of taking blood, than there would otherwise be if no blood was available or offered, then WHY are blood transfusions still the first choice of their physicians in the situations where they are warranted?
Farkel