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A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

[L'approche systématique et multidisciplinaire diminue le recours aux produits sanguins allogènes chez les malades opérés du coeur]

From the Department of Cardiac Anaesthesia, CHU Charleroi, Jumet, Belgium.

Address correspondence to: Dr. Philippe Van der Linden, Department of Cardiac Anaesthesia, C.H.U. Charleroi, 73, route de Gosselies, B-6040 Jumet, Belgium. Phone: 32 71 251 572; Fax: 32 71 251 583; E-mail: pvanderlinden{at}skynet.be

Purpose: Individual and institutional practices remain an independent predictor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients.

Methods: This prospective non randomized observational study evaluated the effects of a standardized multidisciplinary transfusion strategy on allogeneic blood products exposure in patients undergoing non-emergent cardiac surgery. The developed strategy involved a standardized blood conservation program and a multidisciplinary allogeneic blood transfusion policy based mainly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1997 to August 1998 (Group pre: n=321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 1998 to August 1999 (Group post: n=315) when the transfusion strategy was applied uniformly.

Results: Patient populations and surgical procedures were similar. Patients in Group post underwent acute normovolemic hemodilution more frequently, had a higher core temperature at arrival in the intensive care unit and presented lower postoperative blood losses at day one. Three hundred forty units of packed red blood cells were transfused in 33% of the patients in Group pre whereas 161 units were transfused in 18% of the patients in Group post (P <0.001). Pre- and postoperative hemoglobin concentrations, mortality and morbidity were not different among groups.

Conclusion: Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.

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