Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass

Background: Abnormal bleeding after cardiopulmonary bypass (CPB) is a commo n complication of cardiac surgery, with important health and economic conse quences. Coagulation test-based algorithms may reduce transfusion of non-er ythrocyte allogeneic blood in patients with abnormal bleeding. Methods: The authors performed a randomized prospective trial comparing all ogeneic transfusion practices in 92 adult patients with abnormal bleeding a fter CPB. Patients with abnormal bleeding were randomized to one of two gro ups: a control group following individual anesthesiologist's transfusion pr actices and a protocol group using a transfusion algorithm guided by coagul ation tests. Results: Among 836 eligible patients having all types of elective cardiac s urgery requiring CPB, 92 patients developed abnormal bleeding after CPB (in cidence, 11%). The transfusion algorithm group received less allogeneic fre sh frozen plasma in the operating room after CPB (median, 0 units; range, 0 -7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating ro om after CPB was 4 (range, 0-12) in the algorithm group compared with 4 (ra nge, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) med iastinal blood loss was significantly less in the algorithm group. Multivar iate analysis demonstrated that transfusion algorithm use resulted in reduc ed ICU blood loss. The control group also had a significantly greater incid ence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions: Use of a coagulation test-based transfusion algorithm in cardi ac surgery patients with abnormal bleeding after CPB reduced non-erythrocyt e allogeneic transfusions in the operating room and ICU blood loss.