Title |
Protocol guided bleeding management improves cardiac surgery patient outcomes
|
---|---|
Published in |
Vox Sanguinis, April 2015
|
DOI | 10.1111/vox.12279 |
Pubmed ID | |
Authors |
B L Pearse, I Smith, D Faulke, D Wall, J F Fraser, E G Ryan, L Drake, I L Rapchuk, P Tesar, M Ziegenfuss, Y L Fung |
Abstract |
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. A retrospective analysis 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 testing (POCCT) with ROTEM and Multiplate to diagnose the cause of bleeding and monitor treatment. Use of the protocol led to decreases in the incidence of transfusion of PRBCs (47·3% vs. 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 increased (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 < 0·0001). 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% reduction 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. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Australia | 4 | 67% |
New Zealand | 1 | 17% |
Italy | 1 | 17% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Practitioners (doctors, other healthcare professionals) | 3 | 50% |
Members of the public | 2 | 33% |
Science communicators (journalists, bloggers, editors) | 1 | 17% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 77 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 13 | 17% |
Student > Ph. D. Student | 9 | 12% |
Researcher | 9 | 12% |
Student > Postgraduate | 9 | 12% |
Student > Master | 7 | 9% |
Other | 18 | 23% |
Unknown | 12 | 16% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 44 | 57% |
Nursing and Health Professions | 9 | 12% |
Biochemistry, Genetics and Molecular Biology | 2 | 3% |
Agricultural and Biological Sciences | 2 | 3% |
Mathematics | 1 | 1% |
Other | 4 | 5% |
Unknown | 15 | 19% |