A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

Purpose: Individual and institutional practices remain an independent predi ctor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients. Methods: This prospective non randomized observational study evaluated the effects of a standardized multidisciplinary transfusion strategy on allogen eic blood products exposure in patients undergoing non-emergent cardiac sur gery. The developed strategy involved a standardized blood conservation pro gram and a multidisciplinary allogeneic blood transfusion policy based main ly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1 997 to August 1998 (Group pre: n=321), when the transfusion strategy was pr ogressively developed, were compared to those obtained in a second group, i ncluding patients operated from September 1998 to August 1999 (Group post: n = 315) when the transfusion strategy was applied uniformly. Results: Patient populations and surgical procedures were similar. Patients in Group post underwent acute normovolemic hemodilution more frequently, h ad a higher core temperature at arrival in the intensive care unit and pres ented lower postoperative blood losses at day one. Three hundred forty unit s of packed red blood cells were transfused in 33% of the patients in Group pre whereas 161 units were transfused in 18% of the patients in Group post (P < 0.001). Pre- and postoperative hemoglobin concentrations, mortality a nd morbidity were not different among groups, Conclusion: Development of a standardized multidisciplinary transfusion str ategy markedly reduced the exposure of cardiac surgery patients to allogene ic blood.