Acute normovolemic hemodilution in cardiac surgery and the power of global collaboration in advancing research

Acute normovolemic hemodilution (ANH) is a blood conservation strategy in cardiac surgery aimed at reducing perioperative need for transfusion and preserving hemostatic function. While ANH has potential benefits, its global adoption remains heterogeneous and poorly characterized. To investigate current practice patterns, we conducted a rapid international survey among cardiac anesthesiologists, disseminated through the International Academy of Cardiac Anaesthesiologists (IACA) global network and the European Association of Cardiothoracic Anaesthesiology (EACTAIC). We reached specialists from 31 countries, with 28 providing responses: on average, 26.7% of cardiac anesthesiologists reported using ANH and 13.7% of cardiac surgery patients worldwide actually receive ANH, rising to 17.5% when considering a population-weighted mean. Notable regional variability was observed, ranging from 37.3% use in the Americas to just 5.0% in Oceania. These findings reinforce previous reports and underscore the ongoing global disparities in ANH implementation. Moreover, this study highlights the power of international collaboration in addressing knowledge gaps and establishing global benchmarks. By engaging national leaders and taking advantage of inter-societal cooperation, the survey not only provided meaningful insights but also demonstrated the feasibility of rapidly gathering global data on specific perioperative practices. Ultimately, this study lays the groundwork for multicenter research and calls for a large randomized international trial to definitively assess the clinical impact of ANH in cardiac surgery.