Implementation of a transfusion algorithm to reduce blood product utilization in pediatric cardiac surgery.

Whitney G, Daves S, Hughes A, et al.
Paediatr Anaesth 2013;23:639-646.
NATA Rating :
Review by : H. V. New
NATA Review

This study aimed to show the impact of implementing a transfusion algorithm for pediatric cardiac surgery on reducing blood product use in a single center. Prior to introduction of the algorithm, transfusion decisions were taken empirically with variable practice. The algorithm included guidance on hematocrit, platelet count, and fibrinogen level (>70 mg/dL just prior to separation from cardiopulmonary bypass) as thresholds to guide transfusion during the period following protamine reversal prior to arrival on the intensive care unit (ICU). Electronic patient records and blood bank records were used to assess volumes of transfusion, chest tube output during the first 12 hours on ICU, and predischarge mortality.

The 12 months prior to implementation (303 patients) were compared with the 11 months post implementation (246 patients). Following implementation there was a significant reduction in red cell (66%) and cryoprecipitate (86%) intraoperative transfusions (excluding priming of the bypass circuit) without increasing transfusions or postoperative bleeding in the first 12 hours on ICU. There was also a significant decrease in mortality although the reason for this is not clear.

Although it is possible that other factors could have contributed to the change in transfusion practice, the study provides support for introduction of transfusion algorithms in pediatric cardiac surgery. Despite the relatively conservative fibrinogen level used as a threshold, leading to the marked reduction in cryoprecipitate usage, there was no evidence that this resulted in increased adverse outcomes as a result. There are relatively few studies on transfusion for pediatric cardiac surgery, so this study makes a useful contribution to the field.

– Helen V. New