Targeted Bleeding Management Reduces the Requirements for Blood Component Therapy in Lung Transplant Recipients.
OBJECTIVE
Lung transplantation is associated with high rates of bleeding and frequent blood transfusion. The authors aimed to determine if point-of-care coagulation testing (POCCT) reduced transfusion requirements.


METHODS
A before-and-after cohort analysis conducted at a single tertiary referral center. Ninety-three sequential adult patients between January 2010 and January 2014 undergoing isolated lung transplant without preoperative extracorporeal support were analyzed.


METHODS
ROTEM and multi-plate POCCT were introduced on July 1, 2012, with an associated algorithm based on the results.


RESULTS
Statistically significant decreases in the proportion of patients receiving PRBCs (87% v 65%; p = 0.015), FFP (72% v 30%; p<0.0001) and platelets (70% v 37%; p = 0.002) were found after the intervention. There were small decreases in median chest tube blood loss at 2 hours (300 mLs v 215 mLs; p = 0.03) and 4 hours (440 mLs v 350 mLs; p = 0.050) but not at 12 hours postoperatively. There were no changes in reoperation for bleeding (9% v 4%; p = 0.158) or in-hospital mortality (6% v 2%; p = 0.617). The cost of blood products administered decreased from a median of $3,935.00 to $991.00 (p<0.001).


CONCLUSIONS
Use of POCCT in lung-transplant surgery is associated with significant reductions in blood product use and cost. There were no detectable changes in outcome aside from a small decrease in early postoperative bleeding.
Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Queensland, Australia. Electronic address: ian.smith@health.qld.gov.au.
Ian
I
Smith
Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Queensland, Australia; Centre of Health Practice Innovation, Griffith University, Brisbane, Queensland, Australia; Adult Critical Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Bronwyn L
BL
Pearse
Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Daniel J
DJ
Faulke
Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Rishen
R
Naidoo
Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Lisa
L
Nicotra
Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Peter
P
Hopkins
Biostatistics Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom; Biostatistics Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom.
Elizabeth G
EG
Ryan
D000328:Adult; D001777:Blood Coagulation / Q000502:physiology; D001780:Blood Coagulation Tests / Q000191:economics / Q000379:methods; D016913:Blood Component Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000191:economics; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000191:economics; D019106:Postoperative Hemorrhage / Q000097:blood / Q000191:economics / Q000517:prevention & control*; D012189:Retrospective Studies; D066027:Transplant Recipients
blood transfusion; lung transplantation; point-of-care coagulation testing