title: Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program.
abstract: OBJECTIVE
  The study objective was to determine the effects of implementing a blood conservation algorithm on blood product use and outcomes in a community cardiac surgery program.
  
  
  METHODS
  A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes.
  
  
  RESULTS
  Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40% in group II (P < .001). The overall 30-day mortality was 1.3%. There were no differences in mortality, reoperation for bleeding, or other postoperative outcomes between the groups.
  
  
  CONCLUSIONS
  Implementation of a comprehensive blood conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes.
authors.affiliation: Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, NJ, USA. steve.xydas@atlantichealth.org
authors.forename: Steve
authors.initials: S
authors.lastname: Xydas
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Magovern
authors.forename: James P
authors.initials: JP
authors.lastname: Slater
authors.forename: John M
authors.initials: JM
authors.lastname: Brown
authors.forename: Rami
authors.initials: R
authors.lastname: Bustami
authors.forename: Grant V
authors.initials: GV
authors.lastname: Parr
authors.forename: Robert L
authors.initials: RL
authors.lastname: Thurer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003153:Community Health Services / Q000458:organization & administration*; D003661:Decision Support Techniques; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009515:New Jersey; D010976:Platelet Count; D019095:Point-of-Care Systems; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins