Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital

Khan, Jahangir; Green, Emily A.; Chang, Jimmin; Ayala, Alexandria; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D.

doi:10.1051/ject/201749273

Cited by 7 publications

(1 citation statement)

References 29 publications

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“…Ottens, et al, [22] conducted a randomized trial to investigate the role of inline blood gas monitoring in improving perfusion management during CPB [22]. The study utilized the CDI™500 device for Furthermore, Khan, et al, [23] reported on the implementation of blood conservation strategies in open-heart surgery patients requiring CPB [23]. By employing multiple departments in a coordinated effort, this aimed to improve transfusion rates and reduce blood product usage.…”

Section: Quality Improvement Initiativesmentioning

confidence: 99%

Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

Butt

2023

J Cardiol Cardiovasc Res.

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This literature review examines perfusion safety in cardiothoracic surgery, with a primary focus on cardiopulmonary bypass (CPB) and circulatory devices. PRISMA guidelines were followed and various databases, including PubMed, MEDLINE, and Google Scholar, were searched using relevant keywords to identify pertinent studies and literature on the subject. The review traces the historical development of perfusion techniques and underscores the importance of equipment factors, personnel considerations, and perfusion management strategies in ensuring patient safety during CPB and circulatory device usage. Clinical aspects of perfusion safety, encompassing equipment safety features, temperature management, anticoagulation, and blood conservation, are discussed. Non-clinical aspects, including the implementation of standardized protocols, robust training structures, positive team dynamics, and the fostering of a safety-oriented culture, are also examined. Quality improvement initiatives for blood conservation, monitoring, and incident reporting are explored, along with an acknowledgment of the significant contributions of major perfusion societies and boards (AmSECT, SCPS, EBCP) in establishing standards and promoting excellence in the field. Challenges related to device design, patient selection, and perioperative management are addressed, highlighting the need for standardized practices and ongoing research to enhance perfusion safety. This comprehensive review underscores the enduring commitment to advancing perfusion safety and quality through systematic research, education, and collaborative efforts in cardiothoracic surgery.

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Section: Quality Improvement Initiativesmentioning

confidence: 99%

Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

Butt

2023

J Cardiol Cardiovasc Res.

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Encouraging results of blood conservation in neonatal open-heart surgery

Bohuta

Charette

Chan

et al. 2024

The Journal of Thoracic and Cardiovascular Surgery

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Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital Are Maintained 4 Years after Initiation

Khan¹,

Barkin²,

Stanton³

et al. 2022

J Extra Corpor Technol

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Blood product usage is an important outcome for patients undergoing cardiac surgery. In 2015, our center made a concerted effort with multiple departments to focus on reducing transfusion rates in surgical patients requiring cardiopulmonary bypass (CPB). Specific changes included an upgrade of the oxygenator in mid-2015 and, in early 2016, implementation of a hemostasis management system (HMS) that used heparin dose-response titration assays for heparin and protamine management. A retrospective chart review demonstrated significant decreases in the quarterly average of patients receiving packed red blood cells (PRBCs) from a baseline of 26.7% to 22.7% following the oxygenator upgrade (p = .021) and from 22.7% to 8.8% following implementation of the HMS (p = .0017). Platelet usage decreased from an average of 50.5% during the baseline and oxygenator upgrade periods to 22.2% following implementation of the HMS (p < .0001). Usage of fresh frozen plasma (FFP) decreased from an average of 28.2% of cases during the baseline and oxygenator upgrade periods to 10.4% during 2016, and cryoprecipitate usage decreased from 38.5% to 15.4%. Heparin usage averaged 56,903 units before implementation of the HMS, decreasing to an average of 43,796 units following HMS implementation (p < .0001). During the same time periods, protamine usage averaged 340.3 mg and 183.2 mg, respectively. Because improvements achieved during quality initiatives may revert back to their pre-intervention state once the assessment period is over, we performed a second retrospective analysis to determine whether the improvements achieved were maintained during the 48 months following the initial study. During 2017–2020, quarterly average usage of blood products was as follows: PRBCs, 11.9%; platelets, 14.7%; FFP, 6.2%; and cryoprecipitate, 11.5%. Quarterly, average use of heparin and protamine were 31,556 ± 2,757 units and 189 ± 113 mg, respectively. These findings indicate that the improvements achieved were not limited to the duration of the initial quality initiative.

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Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital

Cited by 7 publications

References 29 publications

Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

Encouraging results of blood conservation in neonatal open-heart surgery

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital Are Maintained 4 Years after Initiation

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