Cardiothoracic Surgery Patients Requiring Massive Transfusion: Initial Data From the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR)

Abstract

Purpose: To characterise cardiothoracic (CT) surgery patients requiring massive transfusion (MT) (5 units red blood cells (RBCs) in 4 h) in the ANZ-MTR. Methodology: The ANZ-MTR uses electronically stored data from hospital information systems. All consecutive CT surgery patients who received a MT between Apr 2011 - Sept 2015 at 22 hospitals were included. Survival to hospital discharge was obtained from hospital records. Overall mortality post-discharge was obtained from linkage to the National Death Index. Results: Of 4379 MTR patients, 861 (19.7%) underwent CT surgery; 664 (77.1%) cardiac, 169 (19.6%) thoracic vascular and 28 (3.3%) lung procedures. 442 (66.6%) of cardiac procedures were male with median [interquartile range] age 69 [59-77] years compared to 2680 (61.2%) males aged 63 [47-74] years in the MTR cohort. In cardiac procedures, total fresh frozen plasma: red blood cell ratio (FFP: RBC) for the episode of care was 0.6 [0.4-0.8] compared with 0.5 [0.3-0.8] the MTR cohort. 18.3% of cardiac procedures received prothrombinex compared with 11.0% in the MTR cohort. 461 (75.1%) cardiac patients survived to discharge compared with 72.7% of the MTR cohort. Overall cardiac patient survival post-discharge was 71.8% compared with 68.5% in the MTR cohort. Conclusion: Critically bleeding CT surgery patients in Australia and New Zealand comprise a large proportion of patients requiring MT. Future studies are needed to examine the optimal ratio of blood components (e.g. FFP: RBC) and other patient, procedural and transfusion factors which may influence outcomes in these patients.