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Efficacy, complications, and cost of a comprehensive blood conservation program for cardiac operations
W J Scott1, R Rode, B Castlemain
1Division of Cardiothoracic Surgery, Department of Veterans Affairs Medical Center, Albuquerque, N.M.
Insights
Implementing a blood conservation program reduced blood product transfusions in cardiac surgery patients. Key strategies included limiting aspirin, intraoperative hemodilution, and reinfusing chest drainage, proving effective in reducing blood usage.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Blood transfusion is common in cardiac surgery.
- Optimizing blood management is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive blood conservation program in primary, elective cardiac operations.
Main Methods:
- The program included limiting preoperative aspirin, intraoperative phlebotomy and hemodilution, cell salvage, reinfusion of chest drainage, and accepting a minimum hemoglobin of 8.0 gm/dl.
- Patient characteristics were compared before and after program initiation.
Main Results:
- Transfusion rates decreased from 5.8 units/patient to 4.0 units/patient (p = 0.005).
- Intraoperative withdrawal of blood before cardiopulmonary bypass, bypass duration, and preoperative hematocrit predicted blood use.
- No significant differences in chest tube drainage, postoperative hematology, or complications were observed.
Conclusions:
- The implemented blood conservation program effectively reduced blood product transfusions.
- Intraoperative withdrawal of blood before cardiopulmonary bypass is a key conservation strategy that should be expanded.
Abstract:
We reviewed blood use in 118 consecutive patients who underwent primary, elective cardiac operations in 1989. In June 1989 we initiated a blood conservation program that included attempts to limit preoperative aspirin use, intraoperative phlebotomy and hemodilution, use of a cell conservation device (Electromedics, Inc., Englewood, Colo.) to concentrate residual oxygenator contents, reinfusion of chest drainage, and acceptance of a minimum hemoglobin level of 8.0 gm/dl in stable patients. Patient characteristics were similar for patients operated on both before (n = 58) and after (n = 60) initiation of the blood conservation program, except for age and preoperative aspirin use (both greater in postconservation patients). Fewer blood products were transfused (5.8 +/- 5.7 units per patient before conservation versus 4.0 +/- 7.4 units per patient after conservation; p = 0.005). More complete data were available for 82 patients (40 patients before conservation and 42 after conservation). In the postconservation patients, 20 of 42 had 575 +/- 140 ml of blood withdrawn before cardiopulmonary bypass and reinfused afterward, 26 of 42 had 806 +/- 376 ml of blood processed with the cell conservation device returned, and 21 of 42 patients had an average of 287 +/- 127 ml of chest drainage reinfused. Chest tube drainage, postoperative hematologic parameters, and the prevalence of complications were not significantly different between groups. Stepwise linear regression analysis identified intraoperative withdrawal of blood before cardiopulmonary bypass, bypass duration, and preoperative hematocrit value as predictors of blood use. Intraoperative withdrawal of blood before cardiopulmonary bypass is an important conservation measure, and its use should be expanded.