title: The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery.
abstract: BACKGROUND
  Inappropriate transfusion in cardiac surgery may, in part, be due to empiric transfusion therapy instituted in the absence of timely laboratory data. Therefore, the effect of a transfusion decision algorithm based on intraoperative coagulation monitoring of physicians' transfusion practice and the transfusion outcome was evaluated.
  
  
  METHODS
  In a randomized, controlled trial, cardiac surgical patients determined to have microvascular bleeding at the cessation of cardiopulmonary bypass were assigned to algorithm (A) or standard (S) therapy. Group A was treated with plasma and platelet therapy according to a transfusion algorithm based on on-site coagulation data available within 4 minutes. For Group S, the use of laboratory-based data and the decision to transfuse blood components were at physician discretion.
  
  
  RESULTS
  Sixty-six patients were entered into the study (Group A, n = 30; Group S, n = 36). Other than the fact that there were significantly more female patients in Group S than in Group A, no differences between cohorts in regard to perioperative risk factors for blood transfusion needs were identified. Therefore, gender was factored in as a covariate in the statistical analysis. Group A patients received fewer hemostatic blood component units (p = 0.008) and had fewer total donor exposures (p = 0.007) during the entire hospitalization period. Linear regression analysis of the differences in slopes in Groups A and S for the relationships between the red cell volume lost and the red cell volume transfused (p < 0.03), non-red cell units transfused (p < 0.0001), and total number of blood components transfused (p < 0.0001) demonstrated that physicians' transfusion practice was significantly altered by the use of a transfusion algorithm with on-site coagulation data, independent of surgical blood losses.
  
  
  CONCLUSIONS
  The use of algorithms by transfusion decision makers can serve as an effective physician education intervention.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: G J
authors.initials: GJ
authors.lastname: Despotis
authors.forename: J E
authors.initials: JE
authors.lastname: Grishaber
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011364:Professional Practice; D011479:Protamines / Q000627:therapeutic use
chemical_list: D011479:Protamines