Intra-operative
A number of intra-operative management techniques were noted previously in this paper in Section 5: Alternatives to Blood Transfusion. The predominant technique evident within the literature is intraoperative cell salvage due to its general acceptability with Witness patients11,12,51,56. This is in addition to the use of intraoperative normovolaemic haemodilution, which was utilised in 37 of the 45 Witness patients undergoing cardiac surgery in a study by McCartney et al. 3.
The utilisation of antifibrinolytics, heparinisation and carefully considered surgical techniques are also discussed within the clinical literature3,11,57. An example of this is the use of sternum bone wax as standard for Witness patients in a study by Emmertet al. 58. Other operative aspects such as CPB and cross clamp times were not significantly different between Witness and non-Witness groups in various comparative studies (Table 2).
Another point noted from the literature is the importance of distinctions between adult and paediatric patients. This is highlighted within case reports and series, such as that by Boettcher et al ., who reported on three Jehovah’s Witness infants undergoing cardiac surgery59. In this report, these patients were managed using a miniaturised extracorporeal circuit and increased crystalloid cardioplegia59.