BLOOD CONSERVATION IN CORONARY-ARTERY SURGERY

Background. Most patients undergoing coronary artery bypass surgery re ceive homologous blood transfusions despite the availability of multip le pharmacologic and blood salvage conservation strategies. Methods. T he efficacy of defining strict transfusion criteria as the sole blood conservation strategy was adjudicated prospectively by comparing homol ogous blood product usage in 314 consecutive patients undergoing isola ted primary coronary artery bypass surgery (group 2) with a retrospect ive group of 947 consecutive patients undergoing the same procedure bu t transfused Results. The incidence of red cell transfusion and plasma transfusion decreased from 40.5% to 25.8% and 23.8% to 13.4% in group s 1 and 2, respectively (p < 0.001). The percentage of patients receiv ing no homologous blood products increased from 47.6% in group 1 to 68 .5% in group 2 (p < 0.001). Decreasing body weight and;preoperative he matocrit were found to be highly significant predictors of the need fo r red blood cell transfusion (p < 0.001). Significant postoperative de terminants included intensive care unit and hospital length of stay an d reoperation for bleeding (p < 0.001 each). Conclusions. Because majo r determinant of homologous blood transfusion during coronary bypass a dherence to defined transfusion criteria alone is a simple, safe, and effective strategy for decreasing blood product utilization.