Institutional variability in red blood cell conservation practices for coronary artery bypass graft surgery

Objective:To assess whether substantial institutional variability exists in red blood cell conservation practices associated with coronary artery bypa ss graft (CABG) surgery. Design: Prospective, randomized patient enrollment and data collection. Setting: Twenty-four U.S. academic institutions participating in the Multic enter Study of Perioperative Ischemia. Participants: A well-defined subset of primary CABG surgery patients (n = 7 13) expected to be at low risk for bleeding and exposure to allogeneic tran sfusion. Interventions: None (observational study). Measurements and Main Results: Frequency of use of red blood cell conservat ion techniques was determined among institutions. Correlation was determine d between use of each technique and transfusion of allogeneic red blood cel ls and between use of each technique and median institutional blood loss. S ignificant variability (p < 0.01) was detected in institutional transfusion practice with respect to the use of predonated autologous whole blood, nor movolemic hemodilution, red cell salvage, and reinfusion of shed mediastina l blood. The frequency of institutional use of these techniques was not ass ociated with allogeneic transfusion (r(2) < 0.15) or blood loss (r(2) < 0.1 0) in the low-risk population of patients examined. Conclusions: Institutions vary significantly in perioperative blood conserv ation practices for CABG surgery. Further study to determine the appropriat e use of these techniques is warranted. Copyright (C) 2000 by W.B. Saunders Company.