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[Strategies to reduce the use of blood components in cardiovascular surgery]
Helmgton José Brito de Souza1, Rilson Fraga Moitinho
1Santa Casa de Misericórdia-Hospital Santa Izabel Hospital Salvador, Salvador, BA, Brasil. helmgton@uol.com.br
Insights
This study shows that antifibrinolytics and normovolemic hemodilution effectively reduce blood component use in cardiovascular surgery. Prolonged cardiopulmonary bypass times, especially in elderly patients, increase transfusion needs.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Reducing blood component use in cardiovascular surgery is critical for patient outcomes.
- Strategies like antifibrinolytics and hemodilution are employed to minimize transfusions.
Purpose of the Study:
- To evaluate the effectiveness of specific strategies in reducing blood component utilization.
- To identify patient factors associated with increased transfusion requirements during cardiovascular procedures.
Main Methods:
- A cohort of 101 patients undergoing cardiovascular surgery were treated with antifibrinolytics and normovolemic hemodilution.
- Blood remaining in the cardiopulmonary bypass (CPB) circuit was reinfused.
Main Results:
- The mean use of blood components was low, with 58.4% of patients not requiring any transfusions.
- Patients with CPB times exceeding 120 minutes were more likely to need hemotransfusion.
- Elderly patients with longer CPB times showed significantly higher postoperative blood component use.
Conclusions:
- The implemented strategies successfully reduced the need for hemotransfusion post-thoracic surgery.
- Cardiopulmonary bypass duration over 120 minutes is a predictor of increased transfusion requirements.
- The combination of advanced age and extended CPB time significantly elevates postoperative blood product utilization.
Objective:
The aim of this study is to evaluate the strategies adopted by our team to reduce the use of bloods components in patients undergoing cardiovascular surgical procedures.
Methods:
Between October 2005 and January 2007, 101 patients were operated. Fifty-one (50.5%) were male and 50 (49.5%) female. Patients' age ranged from 13 to 80 years (mean of 50.76 years). The strategy consisted in using antifibrinolytics and normovolemic hemodilution, and reinfusion of all the blood remaining in the CPB circuit.
Results:
Mean use of blood components was 1.45 UI, red blood cells; 0.75 UI, fresh frozen plasma; 0.89 UI, cryoprecipitate, and 1.43 UI, platelet. Fifty-nine patients (58.4%) had not used blood components and 12 (11.9%) patients used more than 4 UI of red blood cells. In 27 patients (26.7%) whose CPB time was higher than 120 minutes, 17 (63%) needed hemotransfusion. However, 3 (2.97%) developed coagulopathy and 2 (1.98%) needed reoperation due to bleeding. Of the three patients who developed coagulopathy, two were in the elderly subgroup.
Conclusion:
In the presented series, the measures adopted succeeded in reducing the need of hemotransfusion in the postoperative period of thoracic surgery. Patients with CPB time higher than 120 minutes tended to need hemotransfusion. The association of surgery in elderly patients and CPB time over 120 minutes resulted in significantly greater use of blood components postoperatively.
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