Comparison between liberal transfusion, acute normovolemic hemodilution,
and rotational thromboelastometry to optimize use of blood products in
cardiac surgery
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.