A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery

Abstract

Use of streamlined cardiopulmonary bypass circuit and ROTEM may reduce transfusion and reoperation rates and improve perioperative anemia in cardiac surgical patients. This study demonstrates reproducible intraoperative methods for reducing blood product usage and improving outcomes.

Thromboelastography-Directed Transfusion in Cardiac Surgery: Impact on Postoperative Outcomes

“…Finally, our results differ from others with regard to postoperative mortality, in part because of the heterogeneity of reporting in the literature and possibly also because of the nature of procedures included in this cohort. Many investigations provide information about in-hospital or 30-day mortality, with no improvement when TEG is used to guide management [11,20,22,26]. However, Weber and colleagues [1] found significantly improved 6-month mortality in a population undergoing cardiac surgery , similar to the results reported herein.…”

“…Ann Thorac Surg TEG IMPACT ON CARDIAC SURGERY OUTCOMES 2019;107:1313-8 a meaningful reduction in the rate of return to the OR after the introduction of TEG, supporting previous studies [19][20][21][22][23]. This is because in the post-TEG period, bleeding in the context of a normal TEG result would prompt surgical exploration of bleeding rather than treatment of coagulopathy.…”

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

“…Implementation of ROTEM-guided bleeding management algorithms as an essential part of PBM resulted in significant reduction in bleeding, transfusion requirements, complication rates, and hospital costs. Here, the highest evidence is available for cardiovascular surgery [32][33][34][35]45,46,54,55,66,69,[214][215][216][217][218] but data supporting the efficacy and safety of ROTEM-guided bleeding management in other clinical settings are increasing [12,[35][36]92,101,[114][115][116][117][118]172,185,186,189,[219][220][221][222][223][224][225][226][227][228]. Accordingly, Deppe et al [34] reported in their meta-analysis including nine RCTs, eight cohort studies and 8332 patients an odds ratio (OR) of 0.63 (95% CI, 0.56-0.71; P < 0.0001) for patients receiving allogeneic blood products, 0.63 (95% CI, 0.50-0.78; P < 0.0001) for RBC transfusion, 0.31 (95% CI, 0.13-0.74; P < 0.0001) for plasma transfusion, 0.62 (95% CI, 0.42-0.92, P = 0.0292) for platelet transfusion, 0.56 (95% CI, 0.45-0.71; P < 0.00001) for re-exploration due to postoperative bleeding, 0.64 (95% CI, 0.31-1.30; P = 0.1345) for cerebrovascular events, 0...…”

The use of viscoelastic haemostatic assays in the management of major bleeding

“…Conversely, a recent systematic review of 15 randomised trials involving 8737 patients found no significant difference in mortality, reoperation or postoperative recovery (Serraino & Murphy, ), with benefits being the reduction in transfusion requirements only. However, when used in combination with other techniques, such as a smaller bypass circuit (Mehaffey et al , ), or a general package of intervention (Ranucci et al , ) clinical outcomes have been significantly improved.…”