THE EFFECT OF AN INTRAOPERATIVE TREATMENT ALGORITHM ON PHYSICIANS TRANSFUSION PRACTICE IN CARDIAC-SURGERY

Background: Inappropriate transfusion in cardiac surgery may, in part, be due to empiric transfusion therapy instituted in the absence of ti mely laboratory data. Therefore, the effect of a transfusion decision algorithm based on intraoperative coagulation monitoring of physicians ' transfusion practice and the transfusion outcome was evaluated. Stud y Design and Methods: In a randomized, controlled trial, cardiac surgi cal patients determined to have microvascular bleeding at the cessatio n of cardiopulmonary bypass were assigned to algorithm (A) or standard (S) therapy. Group A was treated with plasma and platelet therapy acc ording to a transfusion algorithm based on on-site coagulation data av ailable within 4 minutes. For Group S, the use of laboratory-based dat a and the decision to transfuse blood components were at physician dis cretion. Results: Sixty-six patients were entered into the study (Grou p A, n = 30; Group S, n = 36). Other than the fact that there were sig nificantly more female patients in Group S than in Group A, no differe nces between cohorts in regard to perioperative risk factors for blood transfusion needs were identified. Therefore, gender was factored in as a covariate in the statistical analysis. Group A patients received fewer hemostatic blood component units (p = 0.008) and had fewer total donor exposures (p = 0.007) during the entire hospitalization period. Linear regression analysis of the differences in slopes in Groups A a nd S for the relationships between the red cell volume lost and the re d cell volume transfused (p<0.03), non-red cell units transfused (p<0. 0001), and total number of blood components transfused (p<0.0001) demo nstrated that physicians' transfusion practice was significantly alter ed by the use of a transfusion algorithm with on-site coagulation data , independent of surgical blood losses. Conclusion: The use of algorit hms by transfusion decision makers can serve as an effective physician education intervention.