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The Adherence to an Intraoperative Blood Product Transfusion Algorithm Is Associated With Reduced Blood Product
Megan Lanigan1, Daniel Siers2, Megan Schramski2
1Department of Anesthesiology, University of Minnesota, Minneapolis, MN.
Insights
A viscoelastic-based algorithm reduced blood product transfusions in cardiac surgery patients, including red blood cells (RBCs) and fresh frozen plasma (FFP). However, significant improvements in extubation time or hospital stay were not observed.
Area of Science:
- Anesthesiology
- Transfusion Medicine
- Cardiac Surgery
Background:
- Intraoperative transfusion management in cardiac surgery is complex.
- Optimizing blood product use is crucial for patient outcomes and resource management.
Purpose of the Study:
- To evaluate the effectiveness of a viscoelastic-based algorithm in reducing non-red blood cell (RBC) product administration during adult cardiac surgery.
- To assess the impact of the algorithm on transfusion rates and clinical outcomes.
Main Methods:
- Prospective observational study at a quaternary academic teaching hospital.
- Implementation of a viscoelastic-based intraoperative transfusion algorithm.
- Comparison of transfusion data from 184 cardiac surgical patients with 236 historic controls.
Main Results:
- A significant 43.9% reduction in red blood cell (RBC) units transfused (p = 0.008).
- Non-significant reductions observed for fresh frozen plasma (FFP), platelets, and cryoprecipitate.
- No statistically significant differences in time to extubation, reoperation for bleeding, ICU length of stay (LOS), or hospital LOS.
- Algorithm adherence was 32.7%.
Conclusions:
- Implementation of a viscoelastic-based algorithm led to reduced administration of packed RBCs, FFP, platelets, cryoprecipitate, and cell saver.
- While algorithm-compliant patients received fewer transfusions, key clinical outcomes like extubation time and LOS did not show statistically significant improvement compared to historic controls.
Objective:
To demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce non-RBC product administration in adult cardiac surgical patients.
Design:
A prospective observational study.
Setting:
At a quaternary academic teaching hospital.
Participants:
Cardiac surgical patients.
Interventions:
Viscoelastic-based intraoperative transfusion algorithm.
Measurements And Main Results:
The study authors compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historic controls after implementing a viscoelastic-based algorithm. The authors found a non-significant reduction in transfusion of 23.8% for fresh frozen plasma (FFP) units (0.84 ± 1.4 v 0.64 ± 1.38; p = ns), 33.4% for platelet units (0.90 ± 1.39 v 0.60 ± 131; p = ns), and 15.8% for cryoprecipitate units (0.19 ± 0.54 v 0.16 ± 0.50; p = ns). They found a 43.9% reduction in red blood cell (RBC) units transfused (1.98 ± 2.24 v 0.55 ± 1.36; p = 0.008). There were no statistically significant differences in time to extubation (8.0 hours (4.0-21.0) v 8.0 (4.0-22.3), reoperation for bleeding (15 [12.3%] v 10 [10.6%]), intensive care unit length of stay (ICU LOS) (51.0 hours [28.0-100.5] v 53.5 [33.3-99.0]) or hospital LOS (9.0 days [6.0-15.0] v 10.0 [7.0-17.0]). Deviation from algorithm adherence was 32.7% (48/147). Packed RBC, FFP, platelets, cryoprecipitate, and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with historic controls, whereas times to extubation, ICU LOS, and hospital LOS did not reach significance.
Conclusions:
After the implementation of a viscoelastic-based algorithm, patients received fewer packed RBC, FFP, platelets, cryoprecipitate, and cell saver. Algorithm-compliant patients received fewer transfusions; however, reductions in times to extubation, ICU LOS, and hospital LOS were not statistically significant compared with historic controls.
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