Potential value of transfusion protocols in cardiac surgery

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Transfusion Medicine

Background:

• Cardiac and aortic surgery frequently require allogeneic blood transfusions.
• Both bleeding and transfusions increase morbidity, mortality, and costs in these procedures.
• Current literature reviews transfusion protocols from 1995-2012.

Purpose of the Study:

• To review literature on transfusion protocols in cardiovascular surgery.
• To evaluate the impact of ROTEM/TEG-based coagulation management algorithms on transfusion needs and outcomes.
• To analyze data from 8507 cardiovascular surgical patients.

Main Methods:

• Review of 16 studies published between 1995 and 2012.
• Evaluation of point-of-care (POC) coagulation management algorithms.
• Utilized viscoelastic tests like thromboelastometry (ROTEM) and thrombelastography (TEG).
• Incorporated POC platelet function tests (e.g., whole blood impedance aggregometry).

Main Results:

• POC algorithms significantly reduced allogeneic blood transfusion requirements.
• Incidence of thrombotic/thromboembolic and transfusion-related adverse events decreased.
• Improved patient outcomes were observed in cardiac surgery patients.

Conclusions:

• Implementing comprehensive POC diagnostic bundles is complex but effective.
• Combines diagnostics with specific coagulation factor concentrates (fibrinogen, prothrombin complex concentrate).
• Strict protocols for indications, dosages, and sequences reduce perioperative transfusions and improve outcomes, including 6-month mortality.