Evaluation of a Novel Transfusion Algorithm Employing Point-of-care Coagulation Assays in Cardiac Surgery: A Retrospective Cohort Study with Interrupted Time–Series Analysis

• Published in: Anesthesiology (Philadelphia) Vol. 122; no. 3; pp. 560 - 570
• Main Authors: Karkouti, Keyvan, McCluskey, Stuart A, Callum, Jeannie, Freedman, John, Selby, Rita, Timoumi, Tarik, Roy, Debashis, Rao, Vivek
• Format: Journal Article
• Language: English
• Published: United States Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc 01.03.2015
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Blood Coagulation - physiology; Blood Transfusion - methods; Blood Transfusion - standards; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - standards; Cohort Studies; Humans; Interrupted Time Series Analysis - methods; Interrupted Time Series Analysis - standards; Middle Aged; Point-of-Care Systems - standards; Retrospective Studies
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000000556

BACKGROUND:Cardiac surgery requiring the use of cardiopulmonary bypass is frequently complicated by coagulopathic bleeding that, largely due to the shortcomings of conventional coagulation tests, is difficult to manage. This study evaluated a novel transfusion algorithm that uses point-of-care coagulation testing. METHODS:Consecutive patients who underwent cardiac surgery with bypass at one hospital before (January 1, 2012 to January 6, 2013) and after (January 7, 2013 to December 13, 2013) institution of an algorithm that used the results of point-of-care testing (ROTEM; Tem International GmBH, Munich, Germany; Plateletworks; Helena Laboratories, Beaumont, TX) during bypass to guide management of coagulopathy were included. Pre- and postalgorithm outcomes were compared using interrupted time-series analysis to control for secular time trends and other confounders. RESULTS:Pre- and postalgorithm groups included 1,311 and 1,170 patients, respectively. Transfusion rates for all blood products (except for cryoprecipitate, which did not change) were decreased after algorithm institution. After controlling for secular pre- and postalgorithm time trends and potential confounders, the posttransfusion odds ratios (95% CIs) for erythrocytes, platelets, and plasma were 0.50 (0.32 to 0.77), 0.22 (0.13 to 0.37), and 0.20 (0.12 to 0.34), respectively. There were no indications that the algorithm worsened any of the measured processes of care or outcomes. CONCLUSIONS:Institution of a transfusion algorithm based on point-of-care testing was associated with reduced transfusions. This suggests that the algorithm could improve the management of the many patients who develop coagulopathic bleeding after cardiac surgery. The generalizability of the findings needs to be confirmed.