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Compliance with ESAIC guidelines for fibrinogen concentrate prescription in cardiac surgery: a multicentre French
Dan Longrois1, Pierre Albaladejo2, Damien Bedague2
1Departement of Anaesthesia and Intensive Care, DMU (Département Médico-Universitaire) PARABOL, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, INSERM 1140, Paris, France.
Insights
Fibrinogen concentrate use in cardiac surgery varies by center, but compliance with European guidelines is high at 86.5%. Non-compliance, mainly over-prescription, did not significantly impact patient outcomes.
Area of Science:
- Anesthesiology and Intensive Care
- Cardiovascular Surgery
- Hematology
Background:
- Fibrinogen concentrate may reduce blood transfusions in cardiac surgery patients with bleeding.
- The European Society of Anaesthesiology and Intensive Care (ESAIC) provides guidelines for its use.
- Compliance with these ESAIC guidelines in clinical practice has not been previously studied.
Purpose of the Study:
- To evaluate adherence to ESAIC guidelines for fibrinogen concentrate prescription in adult cardiac surgery patients.
- To assess the primary endpoint of guideline compliance percentage.
- To investigate secondary endpoints including in-hospital mortality and hospital length-of-stay.
Main Methods:
- A multicentre observational cohort study involving 13 French cardiac surgery centers.
- Recruitment of adult patients undergoing cardiac surgery with cardiopulmonary bypass from March 2017 to April 2018.
- Compliance defined by appropriate fibrinogen administration during hypofibrinogenemia and bleeding, or non-administration when criteria were not met.
Main Results:
- Out of 2,649 patients, 374 (14.1%) received fibrinogen concentrate, with significant center-to-center prescription rate variation (p < 0.001).
- Overall compliance with ESAIC guidelines was high at 86.5%, largely due to appropriate non-prescription in many cases.
- Non-compliance (13.5%) was more frequent due to over-prescription (241 patients) than under-prescription (117 patients).
Conclusions:
- Despite significant variation in fibrinogen concentrate prescription rates across centers, overall compliance with ESAIC guidelines is high.
- Non-compliance, primarily driven by over-prescription, was not associated with increased in-hospital deaths or longer hospital stays.
- These findings suggest that current practice largely aligns with guidelines, and deviations may not lead to adverse outcomes.
Background:
Fibrinogen concentrate may reduce allogeneic blood product transfusion in cardiac surgery patients with bleeding associated with acquired hypofibrinogenemia. The European Society of Anaesthesiology and Intensive Care (ESAIC) has issued guidelines, but compliance to these guidelines has not been studied yet.
Methods:
This multicentre observational cohort study was aimed at evaluating the compliance of fibrinogen prescription with ESAIC. Adult patients undergoing cardiac surgery with cardiopulmonary bypass in 13 French cardiac surgery centres were recruited from March 2017 to April 2018. Compliance with ESAIC guidelines was considered whenever patients received fibrinogen in case of hypofibrinogenemia and clinically relevant bleeding, or when patients did not receive fibrinogen concentrate if there was no hypofibrinogenemia and/or no clinically relevant bleeding. The primary endpoint was the percentage of patients who complied those guidelines. Secondary endpoints were to assess the consequences of non-compliance on in-hospital deaths and hospital length-of-stay.
Results:
Among 2,649 adult patients undergoing cardiac surgery with cardiopulmonary bypass, 374 (14.1%) received fibrinogen concentrate. Rates of prescription among centres varied from < 1.0% to 31.2% (p < 0.001). Compliance with guidelines was observed in 2,291 (86.5%) patients, driven by a high number of patients without prescription (N = 2,158; 94.5%). In non-compliance patients (N = 358; 13.5%), fibrinogen over-prescription (N = 241) exceeded under-prescription (N = 117). In multivariate analyses, non-compliance with the guidelines was not significantly associated with in-hospital deaths or hospital stay.
Conclusions:
Fibrinogen concentrate prescription varied significantly among centres but compliance with the ESAIC guidelines was high (86.5%). Non-compliance (13.5%)-mostly due to over-prescription-was not associated with adverse outcomes.
Trial Registration:
Clinicaltrials.gov identifier: (NCT03075774).
