Abstract
ABSTRACTObjective:Cardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery.Methods:Between April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of Ɛ-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence.Results:After three months of protocol implementation, the use of Ɛ-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol.Conclusion:The rational use of blood products associated with infusion of Ɛ-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.
Highlights
Heart surgeries are great procedures associated with high risk of bleeding
Several causes are often described as hemorrhagic complications in postoperative of cardiac surgery, such as preexisting coagulation disorders or caused by surgical trauma and extra-corporal circulation (ECC), hyperthermia, hemodilution, use of intraoperative heparin, technical factors related with the procedure and handling of large vessels[1,2,3]
Patients submitted to myocardial revascularization surgery before the protocol implementation (January to March 2011) was compared with the group of patients included in July to December 2011, i.e., after the protocol implementation that occurred between April and June 2011
Summary
Heart surgeries are great procedures associated with high risk of bleeding. Several causes are often described as hemorrhagic complications in postoperative of cardiac surgery, such as preexisting coagulation disorders or caused by surgical trauma and extra-corporal circulation (ECC), hyperthermia, hemodilution, use of intraoperative heparin, technical factors related with the procedure and handling of large vessels[1,2,3]. More than 50% of patients submitted to heart surgeries received transfusion of high variability. These studies stated that blood products were used in more than 90% of cardiac surgeries[6,7,8,9]. In the United States roughly 20% of all erythrocyte concentration collected are used in cardiac surgeries[6,7,8,9]
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