Prospective Interventional Cohort Study using AIIMS Simplified POC Algorithm for Restricted Blood Transfusion in Cyanotic Children

Abstract

Objectives: The coagulation parameters are known to be deranged in cyanotic congenital heart diseases (CCHDs). Perioperative hemorrhage, as well as massive blood and components transfusion, can cause hemodynamic and metabolic instability, which may lead to multi-organ damage and adversely affect the outcome of a well-performed surgical correction. In recent years, there are a number of studies shown that zero transfusion cardiac surgery, even with cardiopulmonary bypass (CPB), in adult as well as pediatric cardiac surgery is possible. This study yields a newer strategy to reduce over-ordering and transfusion of blood and blood products in cardiac surgeries, and in turn, this will also improve the outcome of cardiac surgeries, especially for CCHDs. Saved blood can save other lives, too. Material and Methods: Total 150 patients of either sex, with cyanotic congenital heart defect (CCHD) undergoing corrective surgery on CPB were used in this randomized controlled interventional cohort study. Written and informed consent was taken. Blood samples for ROTEM (Group A) and standard laboratory coagulation profile (Group B) were collected twice (T1: at aortic declaiming and T2: 10-15 minutes after protamine reversal). Blood and components were transfused according to ROTEM® algorithm or non POC algorithm (as per proposed algorithms) when indicated and outcomes recorded. Results: Despite a significant longer cardiopulmonary bypass time (140 vs. 128.5 min; P=0.019) in the POC group (ROTEM® based algorithm), we found a significant reduction in total drain output (357 vs. 426 mL; P=0.002), blood components transfusion (packed red blood cells, 3.0 vs. 6.0 U, P>0.001; plasma, 1 vs. 2 U, P<0.001; and platelets, 1 vs. 4 U, P<0.001), incidence of postoperative complications(42.5% vs. 65.7%, P=0.004), as well as duration of ICU stay (5 vs. 9 days, P=0.003). The reduction of in-hospital mortality was not significant (6.25% vs. 14.29%, P=0.102). Conclusion: ROTEM® based POC algorithm will guide us for rational blood components utilization and also help to reduce transfusion-related complications and duration of ICU stay.. Risk awareness and our easily interpretable algorithm will be helpful in this regard.