Protocol guided bleeding management improves cardiac surgery patient outcomes.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Anesthesia, The Prince Charles Hospital, Brisbane, Qld, Australia.|Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.|Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Qld, Australia.|Center of Health Practice Innovation, Griffith University, Brisbane, Qld, Australia.
B L
http://orcid.org/0000-0003-0048-620X
BL
Pearse
Department of Anesthesia, The Prince Charles Hospital, Brisbane, Qld, Australia.
I
I
Smith
Department of Anesthesia, The Prince Charles Hospital, Brisbane, Qld, Australia.
D
D
Faulke
Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
D
D
Wall
Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Qld, Australia.|Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia.
J F
JF
Fraser
School of Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.|Biostatistics Department, King's College London, Denmark Hill, UK.
E G
EG
Ryan
Cardiac Surgery Clinical Information Service, The Prince Charles Hospital, Brisbane, Qld, Australia.
L
L
Drake
Department of Anesthesia, The Prince Charles Hospital, Brisbane, Qld, Australia.
I L
IL
Rapchuk
Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
P
P
Tesar
Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Qld, Australia.|Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia.
M
M
Ziegenfuss
Center of Health Practice Innovation, Griffith University, Brisbane, Qld, Australia.|Inflammation and Healing Research Cluster, School of Health & Sports Sciences, University of Sunshine Coast, Sunshine Coast, Qld, Australia.
Y L
YL
Fung
D000368:Aged; D001780:Blood Coagulation Tests; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage
D014148:Tranexamic Acid
bleeding management protocol; haemostasis; patient blood management; transfusion - surgery