Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program

Steve Xydas, Christopher J. Magovern, James Slater, John Brown, Rami Bustami, Grant V. Parr, Robert L. Thurer

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: The study objective was to determine the effects of implementing a blood conservation algorithm on blood product use and outcomes in a community cardiac surgery program. Methods: A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes. Results: Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40% in group II (P < .001). The overall 30-day mortality was 1.3%. There were no differences in mortality, reoperation for bleeding, or other postoperative outcomes between the groups. Conclusions: Implementation of a comprehensive blood conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes.

Original languageEnglish (US)
Pages (from-to)926-935
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number4
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

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Thoracic Surgery
Blood Platelets
Erythrocytes
Mortality
Reoperation
Hemoglobins
Perfusion
Demography
Hemorrhage
Research

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Xydas, Steve ; Magovern, Christopher J. ; Slater, James ; Brown, John ; Bustami, Rami ; Parr, Grant V. ; Thurer, Robert L. / Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 4. pp. 926-935.
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abstract = "Objective: The study objective was to determine the effects of implementing a blood conservation algorithm on blood product use and outcomes in a community cardiac surgery program. Methods: A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes. Results: Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40{\%} in group II (P < .001). The overall 30-day mortality was 1.3{\%}. There were no differences in mortality, reoperation for bleeding, or other postoperative outcomes between the groups. Conclusions: Implementation of a comprehensive blood conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes.",
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Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program. / Xydas, Steve; Magovern, Christopher J.; Slater, James; Brown, John; Bustami, Rami; Parr, Grant V.; Thurer, Robert L.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 4, 01.01.2012, p. 926-935.

Research output: Contribution to journalArticle

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