Emergency Situations
It is now considered relatively common to carry out uncomplicated elective cardiac surgery on Witnesses, as this enables meticulous planning and execution of blood management strategies. However, emergency cardiac surgery does not allow for careful planning, presenting a greater challenge and thus increasing the risk of bleeding both peri- and post- operatively. Under such circumstances the doctor has a legal right to determine whether to proceed with a blood transfusion if they cannot clearly ascertain the refusal of blood products5. Emergency cardiac surgery in witnesses presents additional problems; presentation with severe anaemia and bleeding is inherently difficult to manage without the transfusion of blood. Research by Viele and Weiskopf found Witnesses that did not receive transfusions, 50 mortalities occurred due to anaemia, with a haemoglobin of ≤8 g/dl or a haematocrit of ≤24%60. This has since been supported by Hogervorst et al . who highlighted an association between low haemoglobin levels (<8g/dl) and levels of mortality and morbidity55. Contrary to this, a study carried out over a ten year period on 91 Witnesses undergoing cardiac surgery, found no significant difference in the risk of mortality or major complications between those who received emergency compared to elective surgery52. The differences in outcomes between Witness and non-Witness patients in the clinical literature is important to explore in order to ascertain the impact of refusal of blood and blood products on these patients.