Protocol guided bleeding management improves cardiac surgery patient outcomes.

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Transfusion Medicine

Background:

• Excessive bleeding is a common risk in cardiac surgery, often necessitating blood product transfusions.
• Transfusions, while necessary, can be associated with adverse postoperative outcomes.
• An evidence-based approach to bleeding management is crucial for optimizing patient care.

Purpose of the Study:

• To analyze the impact of a quality initiative implementing an evidence-based bleeding management protocol.
• To evaluate the effectiveness of point-of-care coagulation testing (POCCT) in guiding transfusion decisions.

Main Methods:

• Retrospective analysis comparing outcomes before and after protocol implementation.
• Protocol utilized ROTEM and Multiplate for real-time coagulation assessment.
• Data collected on blood product transfusion rates, patient outcomes, and costs.

Main Results:

• Significant reductions in transfusions of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets.
• Increased use of cryoprecipitate and tranexamic acid.
• Decreased rates of re-exploration for bleeding, wound infections, and length of hospital stay.
• Substantial cost savings in blood product acquisition.

Conclusions:

• Implementation of a POCCT-supported bleeding management protocol in cardiac surgery is effective.
• The protocol leads to reduced allogeneic blood product transfusion.
• Improved patient outcomes and significant cost reductions were observed.