A recent publication in Anesthesia and Analgesia by Eugene A. Hessel and Jerrold H. Levy(2), discuss the survey (that was mentioned in the previous ICEBP Newsletter
) on the effects of the Ferraris Practice Guidelines on Perioperative Blood Transfusion and Conservation in Cardiac Surgery(3).
Although the results of it were disappointing (namely an apparent lack of effect of the Ferraris guidelines in real-world practice) , the survey is appreciated because it touches on some burning issues that are worthwhile discussing. While surveys have inherent limitations, and the surgical profession chose not to participate, Drs. Hessel and Levy provide a critical look at the existing guidelines that are produced today.
Due to the growing ‘popularity’ of modern guidelines (everybody likes them, all for different (misused) reasons), the developers of guidelines often base them on lower levels of evidence; leading to guidelines that may not improve outcome, but even more tragic, lead to worse outcomes. Therefore, the whole process of guidelines developing should be reviewed.
Although the authors do not question the use of clinical practice guidelines, they do object to [...the promulgation of guidelines that are based on low-level evidence that sometimes proves to be wrong and gives the whole process a bad reputation that leads to skepticism, lack of trust, and poor adoption by medical practitioners].
The emphasis should lay first on producing more evidence, then produce stronger guidelines. But the (correct) developed guidelines should not be abandoned, because they point out the hiatuses in existing eveidence.
In their closing remarks, the authors conclude that there is an obligation to improve the quality of the guidelines, and that for the implementation of them into clinical practice, the collaboration of three professional groups is required - anesthesiologists, surgeons and perfusionists.
2. Hessel EA, Levy JH Guidelines for Perioperative Blood Transfusion
and Conservation in Cardiac Surgery: Lessons and Challenges Anesth Analg 2010; 111 (6): 1555–9
3. Likosky DS, FitzGerald DC, Groom RC, Jones DK, Baker RA, Shann KG, Mazer D, Spiess BD, Body SC. Effect of the perioperative blood transfusion and blood conservation in cardiac surgery clinical practice guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices Anesth Analg 2010; 111: 316–23