title: Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes.
abstract: Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes.
authors.affiliation: Department of Cardiovascular Perfusion, Childrens of Alabama, Birmingham, Alabama.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Timpa
authors.affiliation: Department of Cardiovascular Perfusion, Childrens of Alabama, Birmingham, Alabama.
authors.forename: L Carlisle
authors.initials: LC
authors.lastname: O'Meara
authors.affiliation: Department of Cardiovascular Perfusion, Childrens of Alabama, Birmingham, Alabama.
authors.forename: Kellen G
authors.initials: KG
authors.lastname: Goldberg
authors.affiliation: Department of Cardiovascular Perfusion, Childrens of Alabama, Birmingham, Alabama.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Phillips
authors.affiliation: Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jack H
authors.initials: JH
authors.lastname: Crawford
authors.affiliation: Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Jackson
authors.affiliation: Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alten
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002675:Child, Preschool; D006284:Health Plan Implementation; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D015994:Incidence; D007223:Infant; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000458:organization & administration; D019990:Perioperative Care / Q000379:methods / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration
keywords: bleeding; cardiac surgery; pediatric; protocol; quality improvement; transfusion