https://doi.org/10.1177/0267659117733810 Perfusion 1–9 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659117733810 journals.sagepub.com/home/prf Introduction Many factors impact on decisions in cardiac surgery to administer blood products, including hemoglobin (Hb)/hematocrit (Hct) exceeding a particular value, an increase in lactate and a decrease in oxygen saturation. The administration of blood products is not without consequence and recent research continues to show the negative consequences of blood product administra- tion. 1,2 While this is not necessarily a newly recognized phenomenon, many of the reported studies involve adult cardiac surgical patients. Recent studies, however, are starting to show the negative impact associated with Comprehensive blood conservation program in a new congenital cardiac surgical program allows bloodless surgery for the Jehovah Witness and a reduction for all patients Vincent Olshove, 1 Nicole Berndsen, 1 Veena Sivarajan, 1 Pooja Nawathe 2 and Alistair Phillips 3 Abstract Background: Cardiac surgery on Jehovah's Witnesses (JW) can be challenging, given the desire to avoid blood products. Establishment of a blood conservation program involving the pre-, intra- and post-operative stages for all patients may lead to a minimized need for blood transfusion in all patients. Methods: Pre-operatively, all JW patients were treated with high dose erythropoietin 500 IU/kg twice a week. JW patients were compared to matching non-JW patients from the congenital cardiac database, two per JW to serve as control. Blood use, ventilation time, bypass time, pre-operative hematocrit, first in intensive care unit (ICU) and at discharge and 24 hour chest drainage were compared. Pre-operative huddle, operating room huddle and post-operative bedside handoff were done with the congenital cardiac surgeon, perfusionist, anesthesiologist and intensive care team in all patients for goal alignment. Results: Five JW patients (mean weight 24.4 ± 25.0 Kg, range 6.3 – 60 Kg) were compared to 10 non-JW patients (weight 22.0 ± 22.8 Kg, range 6.2 – 67.8 Kg). There was no difference in bypass, cross-clamp, time to extubation (0.8 vs. 2.1 hours), peak inotrope score (2.0 vs. 2.3) or chest drainage. No JW patient received a blood product compared to 40% of non-JW. The pre-operative hematocrit (Hct) was statistically greater for the JW patients (46.1 ± 3.3% vs. 36.3 ± 4.7%, p<0.001) and both ICU and discharge Hct were higher for the JW (37 ± 1.8% vs 32.4 ± 8.0% and 41 ± 8.1% vs 34.8 ± 7.9%), but did not reach statistical significance. All patients had similar blood draws during the hospitalization (JW x 18 mL/admission vs non-JW 20 mL/admission). Conclusion: The continuous application and development of blood conservation techniques across the continuum of care allowed bloodless surgery for JW and non-JW patients alike. Blood conservation is a team sport and to make significant strides requires participation and input by all care providers. Keywords bloodless; Jehovah’s Witness; blood conservation; congenital 1 Congenital Heart Program, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 2 Critical Care Medicine, Congenital Cardiac Intensive Care Unit, Depart- ment of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA 3 Division of Cardiothoracic Surgery, Department of Surgery, Cedars- Sinai Medical Center, Los Angeles, CA, USA Corresponding author: Vincent Olshove, Congenital Heart Program, Heart Institute, Cedars Sinai Medical Center, 127 S San Vicente Blvd, A3600, Los Angeles, CA, 90048, USA. Email: volshove.1@gmail.com Presented at the 38th Annual Seminar of The American Academy of Cardiovascular Perfusion, San Diego, California, 19-22 January 2017 733810PRF 0 0 10.1177/0267659117733810PerfusionOlshove et al. research-article 2017 Original Paper