A Cardiopulmonary Bypass Based Blood Management Strategy in Adult Cardiac Surgery
DOI:
https://doi.org/10.1532/hsf.1792Keywords:
blood managementAbstract
Background: Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open-heart surgical procedures. Efforts should be made to decrease or completely avoid transfusions to avoid these negative reactions.
Methods: Our coronary artery bypass grafting database was reviewed retrospectively and a total of 243 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) were studied in a 12-month period (January-December 2016) after the implementation of the new program, and compared with 275 patients of the previous 12-month period.
All the staff involved in the care of the patients were educated about the risks and benefits of blood transfusions and the new transfusion guidelines in a 45-min training. We revised our guidelines for transfusions based on the STS. A transfusion log was created. Reduction in IV fluid volume was targeted. CPB circuitry was redesigned to achieve significantly less prime volume.
Results: The proportion of patients transfused with red blood cells was 56% (n =154) in the control group and reduced by 26.8% in the study group (29.2%; 71 patients;
P < .01). Blood transfusion rate (1.7 ± 1/3.05 ± 1 units), postoperative hemorrhage (545 ± 50/ 775 ± 55 mL), respiratory support duration (12.4 ± 7/16.8 ± 8 h) and ICU stay (2.2±1.1/ 3.5±1.2 days) were significantly better in the blood conservation group.
Conclusion: These findings, in addition to risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in adult cardiac operations.
References
Arnold DM, Fergusson DA, Chan AK, et al. 2006. Avoiding transfusions in children undergoing cardiac surgery: a meta- analysis of randomized trials of aprotinin. Anesth Analg 102:731-7.
Escobar GA, Cheng AM, Moore EE, et al. 2007. Stored packed red blood cell transfusion upregulates inflammatory gene expression in circulating leukocytes. Ann Surg 246:129-34.
Farmer SL, Towler SC, Leahy MF, Hofmann A. 2013. Drivers for change: Western Australia Patient Blood Management Program (WA PBMP), World Health Assembly (WHA) and Advisory Committee on Blood Safety and Availability (ACBSA). Best Pract Res Clin Anaesthesiol 27:43-58.
Ferraris VA, Brown JR, Despotis GJ, et al. 2011. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91:944-82.
Gourlay T, Olivencia-Yurvati AH, Gunaydin S. 2008. STS blood conservation guidelines: the role of leukocyte filtration. Ann Thorac Surg 85:1138-9.
Gunaydin S, Sari T, McCusker K, Schonrock U, Zorlutuna Y. 2009. Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function. Perfusion 24:153-62.
Gunaydin S, McCusker K, Vijay V. 2011. Perioperative blood conservation strategies in pediatric patients undergoing open-heart surgery: impact of non-autologous blood transfusion and surface-coated extracorporeal circuits. Perfusion 26:199-205.
McCusker K, Chalafant A, De Foe G, Gunaydin S, Vijay V. 2006. Influence of hematocrit and pump prime on cerebral oxygen saturation in on-pump coronary revascularization. Perfusion 21:149-55.
Menkis AH, Martin J, Cheng DC, et al. 2012. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: A consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. Innovations (Phila) 7:229-41.
Murphy MF, Murphy GJ. 2013. 2011 Audit of Blood Transfusion in Cardiac Surgery. 2013. Available at: http://hospital.blood.co.uk/media/26859/nca2011_use_of_blood_in_adult_cardiac_surgery_report.pdf. Accessed February 24, 2015.
Senay S, Toraman F, Gunaydin S, Kilercik M, Karabulut H, Alhan C. 2009. The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study. Interact CardioVasc Thorac Surg 8:93-9.
