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Implementation of a transfusion algorithm to reduce blood product utilization in pediatric cardiac surgery
Gina Whitney1, Suanne Daves, Alex Hughes
1Division of Pediatric Cardiac Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. gina.whitney@vanderbilt.edu
Insights
Implementing an objective transfusion algorithm in pediatric cardiac surgery significantly reduced blood product use and mortality. This standardized practice did not increase postoperative bleeding, improving patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Quality Improvement
Background:
- Blood transfusions are common after pediatric cardiopulmonary bypass (CPB) and linked to adverse outcomes.
- Current transfusion practices in pediatric cardiac surgery often rely on clinical judgment rather than objective data.
- Evidence-based transfusion algorithms have shown success in adults but are underutilized in pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the impact of a standardized transfusion protocol on blood product utilization.
- To assess the effect of the algorithm on postoperative bleeding in pediatric cardiac surgery patients.
- To determine the influence of the transfusion algorithm on predischarge mortality.
Main Methods:
- A quality improvement initiative implemented an evidence-based blood product transfusion algorithm.
- Data on blood product utilization, chest tube output, and mortality were collected before and after implementation.
- The study monitored changes in transfusion volumes in the operating room and intensive care unit.
Main Results:
- Blood product utilization decreased significantly: 66% for red cells and 86% for cryoprecipitate post-implementation.
- Postoperative bleeding, measured by chest tube output, did not increase.
- The transfusion algorithm was associated with a 0.247 relative risk of mortality in nontransplant patients.
Conclusions:
- An objective transfusion algorithm effectively reduces blood product use in pediatric cardiac surgery.
- Standardized transfusion protocols improve patient outcomes by lowering mortality without increasing bleeding.
- This approach offers a valuable strategy for enhancing care in pediatric cardiac surgery settings.
Aim:
The goal of this project is to measure the impact of standardization of transfusion practice on blood product utilization and postoperative bleeding in pediatric cardiac surgery patients.
Background:
Transfusion is common following cardiopulmonary bypass (CPB) in children and is associated with increased mortality, infection, and duration of mechanical ventilation. Transfusion in pediatric cardiac surgery is often based on clinical judgment rather than objective data. Although objective transfusion algorithms have demonstrated efficacy for reducing transfusion in adult cardiac surgery, such algorithms have not been applied in the pediatric setting.
Methods:
This quality improvement effort was designed to reduce blood product utilization in pediatric cardiac surgery using a blood product transfusion algorithm. We implemented an evidence-based transfusion protocol in January 2011 and monitored the impact of this algorithm on blood product utilization, chest tube output during the first 12 h of intensive care unit (ICU) admission, and predischarge mortality.
Results:
When compared with the 12 months preceding implementation, blood utilization per case in the operating room odds ratio (OR) for the 11 months following implementation decreased by 66% for red cells (P = 0.001) and 86% for cryoprecipitate (P < 0.001). Blood utilization during the first 12 h of ICU did not increase during this time and actually decreased 56% for plasma (P = 0.006) and 41% for red cells (P = 0.031), indicating that the decrease in OR transfusion did not shift the transfusion burden to the ICU. Postoperative bleeding, as measured by chest tube output in the first 12 ICU hours, did not increase following implementation of the algorithm. Monthly surgical volume did not change significantly following implementation of the algorithm (P = 0.477). In a logistic regression model for predischarge mortality among the nontransplant patients, after accounting for surgical severity and duration of CPB, use of the transfusion algorithm was associated with a 0.247 relative risk of mortality (P = 0.013).
Conclusions:
These results indicate that introduction of an objective transfusion algorithm in pediatric cardiac surgery significantly reduces perioperative blood product utilization and mortality, without increasing postoperative chest tube losses.
