Clinical Pharmacist Novant Health Forsyth Medical Center, United States
Introduction: Cardiac surgery patients are at high risk of bleeding and account for the highest overall rates of perioperative red blood cell (RBC) transfusions. Current guidelines recommend incorporation of viscoelastic testing (VET) to reduce blood product transfusions in cardiac surgery patients due to known risks of transfusions. VET offers a functional assessment of coagulation status.
This practice site, a 900-bed community hospital, implemented a VET-guided transfusion program for patients undergoing cardiac surgery in March 2023. Baseline, intraoperative, and postoperative VET is performed on each patient undergoing cardiac surgery, and interpretation guidance is offered based upon an internal protocol. The multidisciplinary team uses VET to aid decision-making regarding product use for post-operative bleeding.
Methods: This study is a single-center pre-post study conducted in 490 patients. The primary objective of this study was to compare the incidence of perioperative blood product transfusion in cardiac surgery patients one year prior to and one year after VET implementation. Secondary objectives include quantification of product use in both groups and protocol compliance in the post-VET group.
Results: Of the 490 patients included, 245 were in both the pre-VET and post-VET groups. Most patients underwent isolated coronary artery bypass (61%). There was an equal number of emergent, urgent, and elective cases among both groups. Median cardiopulmonary bypass time was 105 minutes and 104 minutes, respectively. Total blood product transfusion, which included RBCs, platelets, cryoprecipitate, and plasma, was significantly lower in the post-VET group (1516 vs 1231 units, p=0.017). There was a non-statistically significant reduction in pRBC transfusions (804 vs 694 units, p=0.111). There was a significant reduction in cryoprecipitate usage (285 vs 82 units, p=0.006). Protocol compliance was 82% in the post-VET group.
Conclusions: The implementation of a VET-guided transfusion program significantly reduced overall blood product use in cardiac surgery patients, primarily driven by a reduction in cryoprecipitate use. A second study will be performed using the post-VET group data to assess barriers to compliance with the goal to further reduce the rate of RBC transfusions and improve outcomes.
