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Effectiveness of a cardiac surgery-specific transfusion protocol
Süleyman Bilecen1, Joris A H de Groot, Cor J Kalkman
1Department of Cardiothoracic Anaesthesia and Intensive Care, Isala Clinics Zwolle, Zwolle, The Netherlands; Department of Anesthesiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
A new cardiac surgery transfusion protocol reduced red blood cell and fresh-frozen plasma use. This specialized protocol also led to fewer myocardial infarctions in patients undergoing cardiac surgery.
Area of Science:
- Cardiology
- Transfusion Medicine
- Surgical Outcomes
Background:
- Cardiac surgery frequently involves significant bleeding, often managed with blood product transfusions.
- A specialized transfusion protocol for cardiac surgery was implemented in 2009.
- The study evaluates the impact of this protocol on blood product transfusion and clinical events.
Purpose of the Study:
- To assess the effectiveness of a cardiac surgery-specific transfusion protocol.
- To determine the protocol's influence on the volume and number of blood products transfused.
- To evaluate the protocol's effect on key clinical outcomes post-cardiac surgery.
Main Methods:
- A nonrandomized intervention study comparing two groups of cardiac surgery patients.
- The index group (2009/2010) received transfusions based on a tailor-made protocol.
- The control group (2007/2008) followed the national transfusion guideline.
Main Results:
- The tailor-made protocol significantly decreased the proportion of patients receiving red blood cells (RBCs) (OR 0.69) and fresh-frozen plasma (FFP) (OR 0.63).
- A notable reduction in myocardial infarctions was observed in the index group (OR 0.67).
- The study included 2534 patients in the index group and 2685 in the control group.
Conclusions:
- The cardiac surgery-specific transfusion protocol optimizes blood product utilization.
- Implementation of this protocol leads to fewer transfusions of RBCs and FFP.
- The protocol is associated with a reduced incidence of myocardial infarction and supports improved coagulation management.
Background:
Cardiac surgery is often complicated by excessive bleeding that is commonly treated with blood products. In the year 2009 a transfusion protocol was introduced specifically designed for cardiac surgery procedures. This study aims to evaluate the effect of this protocol on transfusion of blood products and the occurrence of clinical events.
Study Design And Methods:
This was a nonrandomized intervention study. The index group was transfused according to a tailor-made transfusion protocol (operation in 2009/2010) and the control group was transfused according to the Dutch national transfusion guideline (operation in 2007/2008). The primary outcome was mean number of units transfused and proportion of patients transfused. Secondary outcomes were in-hospital mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, renal injury or failure, rethoracotomy, and prolonged mechanical ventilation.
Results:
The control group comprised 2685 patients and the index group 2534 patients. The tailor-made transfusion protocol resulted in a decrease of patients transfused with red blood cells (RBCs) and fresh-frozen plasma (FFP) during surgery with odds ratio of 0.69 (95% confidence interval [CI], 0.55-0.86) and 0.63 (95% CI, 0.46-0.86), respectively. Fewer myocardial infarctions were observed in the index group with OR of 0.67 (95% CI, 0.47-0.96).
Conclusion:
The cardiac surgery-specific transfusion protocol resulted in fewer patients transfused with RBCs and FFP and a lower incidence of myocardial infarction. This tailor-made protocol has led to a more judicious use of blood products and is a basis for further refinement of coagulation management during cardiac surgery procedures.
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