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Protocol Guided Bleeding Management Improves Cardiac Surgery Patient Outcomes
Journal article   Peer reviewed

Protocol Guided Bleeding Management Improves Cardiac Surgery Patient Outcomes

B L Pearse, I Smith, D Faulke, D Wall, J F Fraser, E G Ryan, L Drake, I L Rapchuck, P Tesar, M Ziegenfuss, …
Vox Sanguinis, Vol.109(3), pp.267-279
2015
DOI: https://doi.org/10.1111/vox.12279
url
https://doi.org/10.1111/vox.12279View
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Abstract

bleeding management protocol haemostasis patient blood management transfusion - surgery
Background and Objectives: Excessive bleeding is a risk associated with cardiac surgery. Treatment invariably requires transfusion of blood products; however, the transfusion itself may contribute to postoperative sequelae. Our objective was to analyse a quality initiative designed to provide an evidenced-based approach to bleeding management. Materials and Methods A retrospective nalysis compared blood product transfusion and patient outcomes 15 months before and after implementation of a bleeding management protocol. The protocol incorporated point-of-care coagulation esting (POCCT) with ROTEM and Multiplate to diagnose the cause of bleeding and monitor treatment. Results Use of the protocol led to decreases in the incidence of transfusion of PRBCs (47.3% s. 32.4%; P < 0.0001), FFP (26.9% vs. 7.3%; P < 0.0001) and platelets (36.1% vs. 13.5%; P < 0.0001). During the intra-operative period, the percentage of patients receiving cryoprecipitate ncreased (2.7% vs. 5.1%; P = 0.002), as did the number of units transfused (248 vs. 692; P < 0.0001). The proportion of patients who received tranexamic acid increased (13.7% to 68.2%; P < .0001). There were reductions in re-exploration for bleeding (5.6% vs. 3.4; P = 0.01), superficial chest wound (3.3% vs. 1.4%; P = 0.002), leg wound infection (4.6% vs. 2.0%; P < 0.0001) and a 12% eduction in mean length of stay from operation to discharge (95%: 9-16%, P < 0.0001). Acquisition cost of blood products decreased by $1 029 118 in the 15-month period with the protocol. Conclusions The implementation of a bleeding management protocol supported by POCCT in a cardiac surgery programme was associated with significant reductions in the transfusion of allogeneic blood products, improved outcomes and reduced cost.

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Hematology

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