loading page

Comparison between liberal transfusion, acute normovolemic hemodilution, and rotational thromboelastometry to optimize use of blood products in cardiac surgery
  • +5
  • Raul Borracci,
  • Julio Baldi,
  • Gustavo Ochoa,
  • Jose Alvarez Gallesio,
  • Romulo Medina Zuñiga,
  • Gustavo Devetach,
  • Michel David,
  • Osvaldo Tenorio Nuñez
Raul Borracci
Departments of Cardiovascular Surgery and Anesthesia, Herzzentrum, Deutsches Hospital, Buenos Aires, Argentina
Author Profile
Julio Baldi
Departments of Cardiac Surgery and Anesthesia, Adventist Cardiovascular Institute, Buenos Aires, Argentina.
Author Profile
Gustavo Ochoa
Departments of Cardiac Surgery and Anesthesia, Adventist Cardiovascular Institute, Buenos Aires, Argentina.
Author Profile
Jose Alvarez Gallesio
Departments of Cardiovascular Surgery and Anesthesia, Herzzentrum, Deutsches Hospital
Author Profile
Romulo Medina Zuñiga
Departments of Cardiovascular Surgery and Anesthesia, Herzzentrum, Deutsches Hospital
Author Profile
Gustavo Devetach
Departments of Cardiovascular Surgery and Anesthesia, Herzzentrum, Deutsches Hospital
Author Profile
Michel David
Herzzentrum, Deutsches Hospital
Author Profile
Osvaldo Tenorio Nuñez
Departments of Cardiovascular Surgery and Anesthesia, Herzzentrum, Deutsches Hospital
Author Profile

Abstract

Background: The objective of this study was to compare liberal and prophylactic transfusion, acute normovolemic hemodilution plus a restrictive on-demand regimen and ROTEM®-guided transfusion protocols to optimize use of blood products and in-hospital outcomes in adult cardiac surgery. Methods: Three cohorts of patients were retrospectively analyzed: 131 patients undergoing all types of cardiac surgery were assigned to liberal transfusion, 117 to normovolemic hemodilution, and 100 to ROTEM-guided transfusion. Eligibility for one or the other protocol was based on the anesthesiologists’ preferences. Results: Utilization of total packed red blood cells was significantly higher in the liberal transfusion protocol (2 units IQR 1-3), with respect to hemodilution and ROTEM® protocols (1 unit, IQR 0-3 and 1 unit, IQR 0-2, respectively) (p<0.001). Median utilization of fresh-frozen plasma was 2 (IQR 1-2), 0 (IQR 0-0), and 0 (IQR 0-0) units in the liberal, hemodilution, and ROTEM® groups (p<0.001), whereas median consumption of platelets was 6 (IQR 5-7), 0 (IQR 0-6), and 0 (IQR 0-0) units, respectively (p<0.001). Hematocrit and hemoglobin levels at discharge were similar in all groups. Reduction in use of blood products did not affect early surgical outcomes. Conclusions: Two combined protocols including restrictive on-demand transfusion associated with acute hemodilution or ROTEM®-guided transfusion decisions significantly decreased total blood product consumption in adult cardiac surgery compared with liberal transfusion. Considering the three approaches, the ROTEM®-guided transfusion protocol was associated with the lowest transfusion requirement for any blood product. This reduction in blood product utilization did not affect early surgical outcomes.