Canadian Journal of Anesthesia

, Volume 48, Issue 9, pp 894–901 | Cite as

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

  • Philippe Van der Linden
  • Stefan De Hert
  • Anne Daper
  • Anne Trenchant
  • Daniel Jacobs
  • Corinne De Boelpaepe
  • Pierre Kimbimbi
  • Pierre Defrance
  • Gaëtan Simoens
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

Individual and institutional practices remain an independent predictor 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 allogeneic blood products exposure in patients undergoing non-emergent cardiac surgery. The developed strategy involved a standardized blood conservation program and a multidisciplinary allogeneic blood transfusion policy based mainly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1997 to August 1998 (Group pre: n = 321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 1998 to August 1999 (Group post: n=3 15) 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, had a higher core temperature at arrival in the intensive care unit and presented lower postoperative blood losses at day one. Three hundred forty units 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 < 0.00l). Preand postoperative hemoglobin concentrations, mortality and morbidity were not different among groups.

Conclusion

Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.

L’approche systématique et multidisciplinaire diminue le recours aux produits sanguins allogènes chez les malades opérés du coeur

Résumé

Objectif

La variabilité de la pratique transfusionnelle demeure un facteur prédictif indépendant de la transfusion sanguine allogénique. Le développement d’une politique transfusionnelle multidisciplinaire standardisée devrait réduire de manière significative l’utilisation de dérivés sanguins allogéniques des patients subissant une intervention chirurgicale lourde.

Méthode

Cette étude prospective non randomisée a évalué les effets d’une stratégie transfusionnelle multidisciplinaire standardisée sur l’exposition aux dérivés sanguins allogéniques de patients subissant une intervention en cardiochirurgie (exception faite des procédures de sauvetage). La stratégie développée repose sur un programme d’épargne sanguine standardisé et une approche transfusionnelle multidisciplinaire uniformisée basée non seulement sur le taux d’hémoglobine, mais aussi sur le jugement clinique. Les données obtenues chez tous les patients opérés entre septembre 1997 et août 1998 (Groupe I, n = 321; mise en place de la stratégie transfusionnelle) ont été comparées à celles obtenues chez les patients opérés dans les mêmes conditions entre septembre 1998 et août 1999 (Groupe II, n = 315; stratégie transfusionnelle appliquée de manière uniforme).

Résultats

Les deux populations ainsi que le type d’intervention étaient comparables. Les patients du Groupe II ont bénéficié plus fréquemment d’une hémodilution normovolémique intentionnelle, sont arrivés aux soins intensifs avec une température corporelle plus élevée et présentaient, au premier jour postopératoire, des pertes sanguines moindres que les patients du Groupe I. Trois cent quarante unités de concentrés érythrocytaires ont été transfusées chez 33 % des patients du Groupe I alors que 161 unités étaient transfusées chez 18 % des patients du Groupe II (P < 0,001). Les taux d’hémoglobine pré-et postopératoire, ainsi que la mortalité et la morbidité hospitalière étaient comparables dans les deux groupes.

Conclusion

Le développement d’une approche transfusionnelle multidisciplinaire standardisée réduit de manière significative l’exposition aux dérivés sanguins allogéniques des patients en chirurgie cardiaque.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Philippe Van der Linden
    • 1
  • Stefan De Hert
    • 1
  • Anne Daper
    • 1
  • Anne Trenchant
    • 1
  • Daniel Jacobs
    • 1
  • Corinne De Boelpaepe
    • 1
  • Pierre Kimbimbi
    • 1
  • Pierre Defrance
    • 1
  • Gaëtan Simoens
    • 1
  1. 1.Department of Cardiac AnaesthesiaCHU CharleroiJumetBelgium

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