Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products?

Introduction. This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical re-intervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. Methods. A retrospective review was conducted of 698 patients who underwent CPB at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 – February 16, 2015 (Period I) and May 16, 2015 - May 16, 2016 (Period II). Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II. Intraoperative and postoperative administration blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay and mortality were recorded. Results. Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p <0.001). TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving FFP and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001). Use of TEG was not observed to significantly decrease postoperative blood product usage or mortality. The median length of hospital stay was reduced by 1 day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). Conclusions. Use of TEG-directed transfusion of blood products following CPB appears to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined.

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Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.334 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S156-S157

Author(s):

M Toprak ◽

I M Asuzu ◽

G Morvillo ◽

F Kiran ◽

B Chae ◽

...

Keyword(s):

Shelf Life ◽

Blood Product ◽

Low Cost ◽

Fresh Frozen Plasma ◽

University Hospital ◽

Blood Component ◽

Blood Products ◽

Staten Island ◽

Team Members ◽

Fresh Frozen

Abstract Introduction/Objective Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage. Methods/Case Report A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned. Results (if a Case Study enter NA) Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1). Conclusion Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.

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Management of Major Obstetric Haemorrhage using ROTEM Point-of-Care Haemostasis Analysers Can Reduce Blood Product usage Without Increasing Fibrinogen Replacement Therapy

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1478 ◽

2018 ◽

Vol 11 (3) ◽

pp. 1167-1176

Author(s):

Beatrice O. Ondondo

Keyword(s):

Blood Loss ◽

Replacement Therapy ◽

Blood Product ◽

Point Of Care ◽

Blood Products ◽

Transfusion Therapy ◽

Product Usage ◽

Obstetric Haemorrhage ◽

Coagulation Tests ◽

Fibrinogen Replacement Therapy

Major obstetric haemorrhage (MOH) is a leading cause of maternal death and morbidity, with the majority of deaths occurring within four hours of delivery. Therefore, prompt identification of women at risk of MOH is crucial for the rapid assessment and management of blood loss to urgently restore haemodynamic stability. Furthermore, as the rate of blood loss during MOH can increase rapidly in the time when laboratory results are awaited, the management of MOH could benefit from point-of-care coagulation testing by the ROTEM analyser which has a quicker turnaround time compared to standard laboratory coagulation tests. A number of studies indicate that ROTEM-based management of MOH has resulted in a significant reduction in massive transfusions and decreased transfusion of concentrated red cells (CRC) and fresh frozen plasma (FFP) due to a reduction in total blood loss. Several reports which have linked MOH to the depletion of fibrinogen reserves indicate that the reduction in CRC and FFP transfusions is largely due to an increase in early fibrinogen replacement therapy which corrects hypofibrinogenemia. This short report discusses preliminary findings on the impact of ROTEM point-of-care haemostasis analyser on the transfusion of various blood products to obstetric women experiencing MOH at the Royal Gwent Hospital in South wales. The number of blood products transfused following decisions based on the ROTEM analyser measurements (ROTEM group) was compared to historical transfusion data before the ROTEM analyser became available (Pre-ROTEM group). Blood product transfusion in the Pre-ROTEM group was guided by measurements of standard laboratory coagulation tests in conjunction with the established major haemorrhage protocols at the time. The findings indicate that the ROTEM analyser was effective in managing MOH at point-of-care and led to a reduction in the transfusion of CRC, FFP and platelets. However, contrary to published studies, the reduction in blood product usage was not accompanied by an increase in fibrinogen replacement transfusion therapy, suggesting that the ROTEM’s FIBTEM assay accurately quantified fibrinogen levels based on fibrin-clot firmness to enable an early diagnosis of hypofibrinogenemia. Early establishment of the absence of hypofibrinogenemia helped to prevent unnecessary transfusion of fibrinogen concentrate in this study. These findings support the adoption of routine use of ROTEM analysers at point-of-care on labour wards to manage MOH and reduce fibrinogen replacement therapy. The ease of use and rapidity of ROTEM tests could enable departure from globally directed correction of coagulopathy during MOH to a more focussed and precise target transfusion therapy, which will ultimately reduce blood product wastage (including fibrinogen concentrate) whilst minimising transfusion-associated side effects such as alloimmunisation, circulatory overload and dilutional coagulopathy.

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Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Anesthesiology ◽

10.1097/aln.0000000000003017 ◽

2020 ◽

Vol 132 (1) ◽

pp. 95-106 ◽

Cited By ~ 5

Author(s):

Audrey Dieu ◽

Maria Rosal Martins ◽

Stephane Eeckhoudt ◽

Amine Matta ◽

David Kahn ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Postoperative Bleeding ◽

Fresh Frozen Plasma ◽

Postoperative Blood Loss ◽

Blood Product Transfusion ◽

Blood Products ◽

Packed Red Blood Cells ◽

Number Of Patients ◽

Fresh Frozen ◽

Frozen Plasma

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. Results Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg−1 (5.1, 9.4) in the FFP group and 5.7 ml · kg−1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. Conclusions The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

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Clinical Features and Outcomes in Patients with Heparin-Induced Thrombocytopenia (HIT): Report of the CAMC HIT Registry.

Blood ◽

10.1182/blood.v104.11.2069.2069 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2069-2069 ◽

Cited By ~ 2

Author(s):

James N. Frame ◽

Elaine Davis ◽

Joan Reed ◽

Ying Wang ◽

Mary Emmett

Keyword(s):

Cardiac Surgery ◽

Clinical Features ◽

Academic Medical Center ◽

Tertiary Care ◽

Hospital Length Of Stay ◽

Thrombin Inhibitor ◽

Graft Occlusion ◽

Composite Outcome ◽

Platelet Counts ◽

Specific Mortality

Abstract In 2001, our tertiary-care academic medical center implemented a HIT Task Force to develop quality improvement (QI) initiatives for HIT (Blood. 102:2766a, 2003). From these initiatives, a CAMC IRB-approved HIT Registry was developed. We present, from inpatient (IP) Registry data, a retrospective analysis of the clinical features/outcomes of patients (pts) reported/identified with clinical HIT from Jan 1999 to June 2003. IP medical records for case selection were identified from archival pharmacy records, the laboratory records of HIT antibody (Ab) assays, and case-reporting. Demographic features, co-morbid conditions, HIT-cohorts, HIT frequency in open heart surgery (OHS) pts, platelet counts (baseline; time HIT 1st suspected, nadir), thromboembolic complications (TEC), HIT Ab testing (H-PF4 ELISA;HIPA), agents utilized for HIT treatment, mean hospital length of stay (LOS), individual/composite outcomes of new TEC, amputations, and all-cause or HIT-specific mortality are presented. Clinical HIT was identified or recorded in 285 pts: 1999: 35, ‘00: 66, ‘01:63, ‘02:67, 1–6.30.03: 54. The median age was 68 yrs (range, 26–90). M/F (%): 47/53. Co-morbidities included coronary artery disease (68%), hyperlipidemia (49%), diabetes mellitus (40%), renal failure (4.6%), active malignancy (2.5%). The median/mean time from initiating heparin (H) to HIT recognition was 8.7/5.0 days. Median platelet counts (mm3) at baseline/time HIT was 1st suspected/HIT nadir were 208,000/72,000/53,000. A H-PF4 or HIPA assay was (+) in 80% (228). HIT cohorts included OHS (187; 66%), medical admission (69; 24%), & non-cardiac surgery (29; 10%) pts. HIT was identified following IP discharge (D/C) in 19% (35/187) of OHS and 10% (3/29) of non-cardiac surgery pts. The OHS HIT frequency among total OHS pts was: 1.8% (187/10,529). TEC at HIT presentation was 43% (123) and included (> 1 event/pt may have occurred): DVT (101), PE (17), graft occlusion (17), MI (10), venous gangrene (4), TIA (4). A new TEC occurred in 14% (41). Anticoagulant therapy for HIT was administered in 88% of Registry pts: r-hirudin (56%), Argatroban (26%) and danaparoid (6%). The mean duration of direct thrombin inhibitor (DTI) therapy/warfarin overlap with a DTI was 8.9 days /4.5 days. Warfarin was administered at D/C in 78% (176/225) pts. The HIT-admission mean LOS was 21days. The all-cause/HIT-specific mortality was 21% (60)/14% (39). Major bleeding /amputation occurred in 9.0%/2.4%. The composite outcome of new TEC, amputation and all-cause death was 26% (75/285). This report is among the largest reported hospital experiences. HIT was identified most frequently after OHS. Delayed HIT after hospital D/C occurred in 13%. Outcomes comparable to prior reports include time to HIT development, clinical HIT Ab detection, OHS HIT frequency, baseline/new TEC, alternative anticoagulant use, all-cause mortality and the composite outcome. QI initiatives arising from this analysis emphasize initiating DTI therapy when HIT 1st suspected and warfarin when platelets are sufficiently recovered; incorporating a prospective tool for scoring the likelihood of HIT; detailed analyses of the delayed-onset HIT cohort and assessing the financial impact of HIT in hospitalized pts.

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Fatal Complication of Transfusion of No Irradiated Blood Product in an Immunocompetent Recipient.

Blood ◽

10.1182/blood.v110.11.4016.4016 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4016-4016

Author(s):

Gregorio Campos-Cabrera ◽

Virginia Campos-Cabrera ◽

Salvador Campos-Cabrera ◽

Jose Luis Campos-Villagomez

Keyword(s):

Rural Areas ◽

World Literature ◽

Blood Product ◽

Leukocytoclastic Vasculitis ◽

Tertiary Care ◽

Solid Organ ◽

Blood Products ◽

Fatal Complication ◽

Wide Range ◽

Hematological Cancers

Abstract Transfusion-associated graft versus host disease (TA-GVHD) is a rare, but almost always a fatal complication. It has a mortality rate above 90%. For the development of TA-GVHD is need immunocompetent cells in the blood product, incompatibility in HLA alloantigen, immune failure of the recipient against the donor cells. The exact incidence is unknown, but more than 200 cases have been reported in the world literature and the molecular test for diagnostic where performed only in a very few of them. Thirty-five years old woman with multiple fractures in right leg from a car accident was treated in her rural town, she received a fresh whole blood transfusion from her sister and then went for surgery, antibiotics and analgesia where given; six days after she developed erytroderma in the upper chest, two days later generalized bone pain and weakness were aggregated, the next day erithroderma generalize and started with diarrhea and jaundice; her evolution was torpid with fever, more weakness and jaundice, pallor, purpura and oropharyngeal pain. She was sent for hematological evaluation to our tertiary care institution, and a TA-GVHD was considerate; a work up on that was performed and the CBC showed pancytopenia, LFT with elevation of bilirubins, transaminases and alkaline phosphatase; the bone marrow aspiration and biopsy with aplasia, the skin biopsy with lymphoid infiltration, junction of epidermis with dermis was intact and no leukocytoclastic vasculitis. She received methylprednisolone, cyclosporine, filgrastim, wide range antibiotics and amphotericin B, leukoreduced and irradiated blood products. Her evolution was torpid with deterioration of her conditions and 48 hour later she died of septic shock. There is no effective treatment for TA-GVHD and no difference between early o delayed diagnostic, the evolution is almost always fatal, that is why the prevention is needed with the leukoreduction and irradiation of blood products, specially in recipients with clear risk for development of TA-GVHD: congenital immunodeficiencies, fetuses y newborns, hematological cancers, solid tumors in chemotherapy, hemopoiectic and solid organ transplanted, and first and second degree relatives. Better policies, technology, education for the primary care physician and access to blood products with high quality is needed to prevent this type of complications, specially in rural areas where transfusions with whole fresh blood from relatives are performed commonly. Figure Figure Figure Figure

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Frequency and Nature of Transfusion Related Adverse Reactions in Patients Admitted in A Tertiary Care Hospital

Bangladesh Journal of Medicine ◽

10.3329/bjm.v33i1.56786 ◽

2021 ◽

Vol 33 (1) ◽

pp. 27-33

Author(s):

Naylla Islam ◽

- Amiruzzaman ◽

Mohammad Ehasun Uddin Khan ◽

Ashim Chakrabarty ◽

Md Arifuzzaman ◽

...

Keyword(s):

Tertiary Care ◽

Fresh Frozen Plasma ◽

Care Hospital ◽

Transfusion Reaction ◽

Blood Products ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Duration Of Storage ◽

Fresh Frozen ◽

Transfusion Reactions

Background:Transfusion of blood and blood products if employed safely, with intensive care can save manyvaluable lives. But a number of transfusion reactions may develop that are sometimesmore serious and life threatening.So this study was done to find out the most frequent and life threatening reactions that develop during transfusion. Methods: A Cross sectional descriptive observational study was performed at a tertiary care centre. Patients of 18 years and older irrespective of sexes who received blood and blood products due to different reasons between April 2020 to September 2020 were included in this study. A total of 96 patients were included in the study. Results:In thisstudy 11(11.5%) out of 96 patients had transfusion reactions of different types .Febrile non haemolytic reaction was the highest with 8 patients (8.33%),followed by Allergic reaction in 2 patients(2.08%) and Acute haemolytic transfusion reaction in 1 patient (1.04%).Among them 7(63.6%) reactions occurred with whole blood , 2(18.2%) reactions occurred with red cell concentrate and 1 reaction occurred with Apheresis platelet (9.1%) and fresh frozen plasma(9.1%).Statistically significant association was found between duration of storage of blood and transfusion reaction. Conclusion: Febrile non haemolytic reaction was the commonest type of transfusion reaction found in this study and there was also statistically significant association between duration of storage of blood and transfusion reaction. Bangladesh J Medicine July 2022; 33(1) : 27-33

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Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

Health SA Gesondheid ◽

10.4102/hsag.v21i0.983 ◽

2016 ◽

Vol 21 ◽

pp. 309-314 ◽

Cited By ~ 1

Author(s):

Bradley Yudelowitz ◽

Juan Scribante ◽

Helen Perrie ◽

Eddie Oosthuizen

Keyword(s):

General Surgery ◽

Orthopaedic Surgery ◽

Blood Product ◽

Current Knowledge ◽

Tertiary Hospital ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Product Use ◽

Infectious Risk ◽

Obstetrics And Gynaecology

Background: Blood products are an expensive and scarce resource with inherent risks to patients. The current knowledge of rational blood product use among clinicians in South Africa is unknown.Purpose of research: To describe the level of clinicians' knowledge related to all aspects of the ordering and administration of blood products from the South African Blood Services for peri-operative patients at a tertiary hospital.Method: A self-administered survey was distributed to 210 clinicians of different experience levels from the departments of Anaesthesiology, General Surgery and Trauma, Orthopaedic Surgery and Obstetrics and Gynaecology at the study hospital. The questions related to risks, cost, ordering procedures and transfusion triggers for red cell concentrate (RCC), fresh frozen plasma (FFP) and platelets.Results: A total of 172 (81.90%) surveys were returned. The overall mean for correctly answered questions was 16.76 (±4.58). The breakdown by specialty was: Anaesthesiology 19.98 (±3.84), General Surgery and Trauma 16.28 (±4.05), Orthopaedic Surgery 13.83 (±4.17) and Obstetrics and Gynaecology 15.63 (±3.51). Anaesthesiology performed better than other disciplines (p < 0.001) and consultants out-performed their junior colleagues (p < 0.001). Seventy percent correctly identified triggers for RCC transfusion and 50% for platelets. Administration protocols were correctly defined by 80% for RCC and FFP just over 50% for platelets. Thirty eight percent of respondents deemed infectious and non-infectious risk sufficient to obtain informed consent. Knowledge of costs and ordering was below 30%.Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

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Oxygen consumption, carbon dioxide production and lactic acid during normothermic cardiopulmonary bypass

Perfusion ◽

10.1177/026765910001500506 ◽

2000 ◽

Vol 15 (5) ◽

pp. 441-446 ◽

Cited By ~ 2

Author(s):

Milo Engoren ◽

Michael Evans

Keyword(s):

Oxygen Consumption ◽

Lactic Acid ◽

Cardiopulmonary Bypass ◽

Anaerobic Metabolism ◽

Tertiary Care ◽

Carbon Dioxide Production ◽

Care Community ◽

Tissue Ischemia ◽

Measure Oxygen Consumption ◽

A Prospective Study

The objective of this study was to measure oxygen consumption, carbondioxide production and lactic acid levels during normothermic cardiopulmonary bypass. A prospective study was undertaken in a tertiary care community hospital, involving 20 adults undergoing cardiopulmonary bypass with prolonged (>65 min) crossclamping of the aorta. O2 consumption, CO2 production, hemoglobin and lactic acid levels were measured 5, 35 and 65 min after crossclamping of the aorta. O2 consumption was 79.7 ± 14.5, 78.8 ± 15.4 and 81.5 ± 14.1 ml/min/m2 at 5, 35 and 65 min after crossclamping the aorta. CO2 production was 61.8 ± 42.9, 60.6 ± 26.3 and 62.2 ± 35.9 ml/min/m2 at the same times. Lactic acid levels were 1.6 ± 0.5 mM/dl at all three times and did not correlate with O2 consumption or CO2 production. In conclusion, although oxygen consumption was low, there was no evidence of abnormal lactate or anaerobic metabolism to suggest tissue ischemia.

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Site-Of-Care Viscoelastic Assay in Major Trauma Improves Outcomes and Is Cost Neutral Compared with Standard Coagulation Tests

Diagnostics ◽

10.3390/diagnostics10070486 ◽

2020 ◽

Vol 10 (7) ◽

pp. 486

Author(s):

Catriona Cochrane ◽

Shalini Chinna ◽

Ju Young Um ◽

Joao D. Dias ◽

Jan Hartmann ◽

...

Keyword(s):

Blood Product ◽

Cost Effective ◽

Blood Products ◽

Major Hemorrhage ◽

Patient Demographics ◽

Trauma Induced Coagulopathy ◽

Significant Difference ◽

Coagulation Tests ◽

One Year ◽

Level 1 Trauma Center

Major hemorrhage is often associated with trauma-induced coagulopathy. Targeted blood product replacement could achieve faster hemostasis and reduce mortality. This study aimed to investigate whether thromboelastography (TEG®) goal-directed transfusion improved blood utilization, reduced mortality, and was cost effective. Data were prospectively collected in a U.K. level 1 trauma center, in patients with major hemorrhage one year pre- and post-implementation of TEG® 6s Hemostasis Analyzers. Mortality, units of blood products transfused, and costs were compared between groups. Patient demographics in pre-TEG (n = 126) and post-TEG (n = 175) groups were similar. Mortality was significantly lower in the post-TEG group at 24 h (13% vs. 5%; p = 0.006) and at 30 days (25% vs. 11%; p = 0.002), with no difference in the number or ratio of blood products transfused. Cost of blood products transfused was comparable, with the exception of platelets (average £38 higher post-TEG). Blood product wastage was significantly lower in the post-TEG group (1.8 ± 2.1 vs. 1.1 ± 2.0; p = 0.002). No statistically significant difference in cost was observed between the two groups (£753 ± 651 pre-TEG; £830 ± 847 post-TEG; p = 0.41). These results demonstrate TEG 6s-driven resuscitation algorithms are associated with reduced mortality, reduced blood product wastage, and are cost neutral compared to standard coagulation tests.

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Inﬂuence of Two Different Types of Cardioplegia on Hemodilution During and After Cardiopulmonary Bypass, Postoperative Chest-Drainage Bleeding and Consumption of Donor Blood Products

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2006.3144 ◽

2006 ◽

Vol 6 (3) ◽

pp. 48-53 ◽

Cited By ~ 3

Author(s):

Mirsad Kacila ◽

Katrin Schäfer ◽

Esad Subašić ◽

Nermir Granov ◽

Edin Omerbašić ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Cardiac Surgical Procedures ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Donor Blood ◽

Chest Drainage ◽

Blood Cardioplegia ◽

Retrospective Clinical Study ◽

Fresh Frozen ◽

Male Patients

The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who underwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilution, bleeding and consumption of donor blood productsin a retrospective clinical study. 100 male patients who underwent cardiac surgical procedure were divided into two groups: 50 patients were administered intermittent normotherm or mild hypotherm (34 degrees C) Calafiore blood cardioplegia with potassium chloride 14,9%; 50 patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardioplegia using hydroxyethyl starch (HES 450/0,7). Hemoglobin values after the first dose of cardioplegia were significantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values 24h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainagebleeding 12h and 24h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after cardiopulmonary bypass and significantly increases the consumption of donor blood products.

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