The Adherence to an Intraoperative Blood Product Transfusion Algorithm Is Associated With Reduced Blood Product Transfusions in Cardiac Surgical Patients Undergoing Coronary Artery Bypass Grafts and Aortic and/or Valve Replacement Surgery: A Single-Center, Observational Study

Objective(s) To demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce blood product administration in adult cardiac surgical patients. Design Prospective observational. Setting Quaternary academic teaching hospital. Participants Cardiac surgical patients. Interventions Viscoelastic-based intraoperative transfusion algorithm. Measurements and Main Results We compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historical controls after implementing a viscoelastic-based algorithm. We found a 43.9% reduction in RBC units transfused (1.98 units ±2.24 vs 0.55 ±1.36; p=0.008). We found a reduction in transfusion of 23.8% for FFP (0.84 units ±1.4 vs 0.64 ±1.38; p=ns), 33.4% for platelets (0.90 units ±1.39 vs 0.60 ±131; p=ns), and 15.8% for cryoprecipitate (0.19 units ±0.54 vs 0.16 ±0.50; p=ns). There was no statistically significant difference in time to extubation (8.0 hours [4.0, 21.0] vs 8.0 [4.0, 22.3], reoperation for bleeding (15 (12.3%) vs 10 (10.6%), ICU LOS (51.0 hours [28.0, 100.5] vs. 53.5 [33.3, 99.0]) or hospital length of stay (9.0 days [6.0, 15.0] vs. 10.0 [7.0, 17.0]). Deviation from algorithm adherence was 32.7% (48/147). PRBC, FFP, platelets, cryoprecipitate and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with Historical Controls while times to extubation, ICU and hospital lengths of stay did not reach significance. Conclusions Following implementation of a viscoelastic-based algorithm, patients received fewer PRBC, FFP, platelets, cryoprecipitate and cell saver. Algorithm Compliant patients received fewer transfusions; however, reductions in times to extubation, ICU and hospital lengths of stay were not statistically significant compared with historical controls.