Implementation of an institutional protocol for rational use of blood products and its impact on postoperative of coronary artery bypass graft surgery

• Published in: Einstein (São Paulo, Brazil) Vol. 11; no. 3; pp. 310 - 316
• Main Authors: Silva, Pedro Gabriel Melo de Barros E, Ikeoka, Dimas Tadahiro, Fernandes, Viviane Aparecida, Lasta, Nilza Sandra, Silva, Debora Prudencio E, Okada, Mariana Yumi, Izidoro, Beatriz Akinaga, Garcia, José Carlos Teixeira, Baruzzi, Antonio Claudio do Amaral, Furlan, Valter
• Format: Journal Article
• Language: English
• Published: Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein 01-07-2013
• Subjects: Aminocaproic Acid - administration & dosage; Antifibrinolytic Agents - administration & dosage; Blood Loss, Surgical - prevention & control; Blood Transfusion - statistics & numerical data; Clinical Protocols; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Disease - surgery; Female; Humans; Male; Middle Aged; Original; Postoperative Period; Treatment Outcome
• ISSN: 1679-4508; 2317-6385
• DOI: 10.1590/S1679-45082013000300009

Cardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery.
Between April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of ε-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence.
After three months of protocol implementation, the use of ε-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol.
The rational use of blood products associated with infusion of ε-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.