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Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis
Katherine D Jones1, Cameron Hatlevig2, Julie A Thompson3
1Staff CRNA, Duke Regional Hospital, Durham, North Carolina.
Insights
Implementing a tranexamic acid (TXA) protocol improved provider adherence for pediatric spine surgery, reducing blood transfusions in idiopathic cases. Neuromuscular cases saw improved compliance but no significant transfusion reduction.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Quality Improvement
Background:
- Pediatric spinal corrective surgery frequently necessitates multiple blood product transfusions.
- Antifibrinolytic agents, notably tranexamic acid (TXA), are increasingly utilized to minimize intraoperative blood loss.
Purpose of the Study:
- To assess provider adherence to a standardized TXA dosing protocol in pediatric corrective spine procedures.
- To evaluate the impact of protocol implementation on blood product usage and antifibrinolytic administration.
Main Methods:
- A retrospective chart review analyzed data from 486 pediatric patients over 9 years.
- Pre- and post-protocol implementation data were compared for cell saver and packed red blood cell (PRBC) administration.
- Provider compliance with TXA dosing and transfusion requirements were assessed.
Main Results:
- Following protocol implementation, idiopathic patients showed a 20% decrease in cell saver use and a 10% decrease in PRBC administration.
- Provider compliance with the TXA dosing protocol increased by 37% in idiopathic patients and 53% in neuromuscular patients.
- Neuromuscular patients, despite increased compliance, did not achieve a statistically significant reduction in transfusion needs.
Conclusions:
- Implementing an antifibrinolytic protocol enhances adherence to recommended TXA dosing.
- Protocol implementation shows potential for reducing intraoperative blood loss and blood product transfusions, particularly in specific pediatric surgical populations.
Abstract:
Pediatric patients who undergo spinal corrective surgery often require multiple blood product transfusions. The use of antifibrinolytics, especially tranexamic acid (TXA), to mitigate intraoperative blood loss has increased in popularity. The goal of this quality improvement project was to evaluate provider compliance with a TXA dosing protocol during pediatric corrective spine procedures. A retrospective chart review was conducted to compare pre- and postimplementation data on cell saver and packed red blood cell (PRBC) administration and dose of antifibrinolytic administered. A total of 486 patients (68% idiopathic and 32% neuromuscular) were evaluated over a 9-year period. Following implementation of the protocol, patients of idiopathic origin experienced a 20% reduction in cell saver administration, a 10% reduction in PRBC administration, and a 37% increase in provider compliance with the dosing protocol. Patients of neuromuscular origin experienced a 53% increase in provider compliance with the recommended TXA dosing protocol; however, this patient population did not experience a statistically significant reduction in transfusion requirements. Implementation of an antifibrinolytic protocol can facilitate compliance with recommended TXA dosing parameters and potentially decrease intraoperative blood loss, reducing blood product transfusion requirements.
