Abstract PR037

Abstract

Background & Objectives: The use of a thromboelastography (TEG) based transfusion algorithm has been shown to reduce transfusion rates of red blood cells (RBC), fresh frozen plasma (FFP) and platelets in cardiac surgery.1 Our aim was to investigate how introduction of TEG and an associated transfusion algorithm changed transfusion practice in our hospital. Materials & Methods: TEG, and an associated transfusion algorithm, was introduced for cardiac surgery in August 2015. With ethics committee approval, we prospectively collected data on blood product use in theatre from August to December 2015 (post-TEG group) and compared it to product use January to July 2015 (pre-TEG group). For a 3.5 month period, each time TEG was used the anaesthetist was surveyed to explain if and how the use of TEG changed management. Results: A raw comparison of blood product use in theatre before and after TEG is shown in the table. Logistical and linear regression models incorporating study group, age, emergency case, time on cardiopulmonary bypass, and redo surgery as potential predictors for transfusion showed no difference in blood product transfusion between groups.In the period anaesthetists were surveyed there were 149 cases, TEG tests were needed in 61 cases, and of these 51 surveys were returned (84% response). 18 (35%) of surveyed anaesthetists thought TEG resulted in less blood product being transfused in that case than otherwise would have occurred, 9 (18%) gave different blood products than otherwise would have occurred, 2 (4%) gave more blood product, 17 (33%) thought TEG did not change management, in 1 (2%) the protocol was not followed, and 4 (8%) returned insufficient comments to assess change in management. Conclusion: There was no change in transfusion rates in theatre after introduction of a TEG-based transfusion protocol in cardiac surgery. Our baseline rates of transfusion were low compared to many published studies showing decreased product use with TEG1. However, when TEG was used, 56% of the time anaesthetists thought it altered their transfusion management, including 35% of the time it reduced the use of blood product.