Blood conservation in cardiac surgery. Preliminary results with an institutional commitment
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G S Tyson1, R N Sladen, V Spainhour
1Department of Surgery, Veterans Administration Medical Center, Durham, North Carolina.
Insights
Implementing blood conservation techniques in cardiac surgery significantly reduced blood product transfusions and donor exposure. This approach decreased costs and patient exposure to allogeneic blood.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Cardiac surgery, particularly Coronary Artery Bypass Grafting (CABG), often requires significant blood product transfusions.
- Blood product use increases risks and costs associated with cardiac procedures.
Purpose of the Study:
- To evaluate the impact of implementing blood conservation techniques on blood product utilization in CABG patients.
- To assess changes in transfusion requirements, donor exposure, and associated costs.
Main Methods:
- A comparative analysis of blood product use in CABG patients before and after the introduction of blood conservation strategies.
- Blood conservation methods included autologous transfusion, autotransfusion, strict transfusion protocols, and acceptance of normovolemic anemia.
Main Results:
- Significant reductions were observed in the mean units of blood transfused per patient (from 6.8 to 2.3) and plasma transfused (from 2.5 to 0.6).
- The percentage of patients receiving no transfusions increased, and total donor exposure per patient decreased significantly (from 13.1 to 4.3).
- While postoperative hematocrit was lower, no difference was noted at 30 days post-discharge.
Conclusions:
- Blood conservation techniques effectively minimize the need for blood product transfusions in cardiac surgery.
- These strategies lead to reduced costs and decreased donor exposure for patients undergoing CABG.
- Further research may be warranted to understand long-term hematological effects.
Abstract:
To evaluate the effect of blood conservation in cardiac surgery, use of blood products was analyzed in patients undergoing CABG before and after implementation of blood conservation techniques. Age, sex, coronary anatomy, ejection fraction, cardiopulmonary bypass time, and the preoperative hematocrit, platelet count, and clotting studies were similar in both groups. Methods of blood conservation included autologous transfusion of blood withdrawn before bypass, autotransfusion of shed mediastinal blood, strict protocols for transfusion, and acceptance of normovolemic anemia. With blood conservation, 25.5% of patients received no transfusions and 54.9% received blood only. Significant reductions (p less than 0.001) were achieved in the transfusion of blood from 6.8 +/- 2.4 to 2.3 +/- 2.6 units per patient and of plasma from 2.5 +/- 2.2 to 0.6 +/- 2.0 units per patient. Reductions in the use of platelets and cryoprecipitate were substantial, although not significant. Total donor exposure was reduced significantly from 13.1 +/- 7.3 to 4.3 +/- 6.7 donors per patient. The postoperative hematocrit was significantly lower and remained so at discharge. However, 30 days later there was no difference. This reduction in transfusion requirements decreased costs and donor exposure.