Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes
Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass...
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| Veröffentlicht in: | The Journal of extra-corporeal technology 2016-03, Vol.48 (1), p.11-18 |
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| container_title | The Journal of extra-corporeal technology |
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| creator | Timpa, Joseph G O'Meara, L Carlisle Goldberg, Kellen G Phillips, Jay P Crawford, Jack H Jackson, Kimberly W Alten, Jeffrey A |
| description | Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients 10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes. |
| doi_str_mv | 10.1051/ject/201648011 |
| format | Article |
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We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes.</description><identifier>ISSN: 0022-1058</identifier><identifier>EISSN: 2969-8960</identifier><identifier>DOI: 10.1051/ject/201648011</identifier><identifier>PMID: 27134303</identifier><language>eng</language><publisher>United States: American Society of ExtraCorporeal Technology</publisher><subject><![CDATA[Blood Transfusion - statistics & numerical data ; Blood Transfusion - utilization ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - statistics & numerical data ; Cardiopulmonary Bypass - adverse effects ; Cardiopulmonary Bypass - methods ; Cardiopulmonary Bypass - statistics & numerical data ; Child, Preschool ; Health Plan Implementation ; Health technology assessment ; Hemofiltration - methods ; Humans ; Incidence ; Infant ; Interdisciplinary Communication ; Original ; Patient Care Team - organization & administration ; Perioperative Care - methods ; Perioperative Care - statistics & numerical data ; Postoperative Hemorrhage - diagnosis ; Postoperative Hemorrhage - epidemiology ; Postoperative Hemorrhage - prevention & control ; Postoperative Hemorrhage - therapy ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Ultrafiltration]]></subject><ispartof>The Journal of extra-corporeal technology, 2016-03, Vol.48 (1), p.11-18</ispartof><rights>Copyright 2016 AMSECT 2016</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3751-16cdb7f1a7ae2715257df11973554d842ccedebeb2ec3c15cdfe9cab7643f61d3</citedby><cites>FETCH-LOGICAL-c3751-16cdb7f1a7ae2715257df11973554d842ccedebeb2ec3c15cdfe9cab7643f61d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850217/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850217/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27134303$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Timpa, Joseph G</creatorcontrib><creatorcontrib>O'Meara, L Carlisle</creatorcontrib><creatorcontrib>Goldberg, Kellen G</creatorcontrib><creatorcontrib>Phillips, Jay P</creatorcontrib><creatorcontrib>Crawford, Jack H</creatorcontrib><creatorcontrib>Jackson, Kimberly W</creatorcontrib><creatorcontrib>Alten, Jeffrey A</creatorcontrib><title>Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes</title><title>The Journal of extra-corporeal technology</title><addtitle>J Extra Corpor Technol</addtitle><description>Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). 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| ispartof | The Journal of extra-corporeal technology, 2016-03, Vol.48 (1), p.11-18 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Blood Transfusion - statistics & numerical data Blood Transfusion - utilization Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - statistics & numerical data Cardiopulmonary Bypass - adverse effects Cardiopulmonary Bypass - methods Cardiopulmonary Bypass - statistics & numerical data Child, Preschool Health Plan Implementation Health technology assessment Hemofiltration - methods Humans Incidence Infant Interdisciplinary Communication Original Patient Care Team - organization & administration Perioperative Care - methods Perioperative Care - statistics & numerical data Postoperative Hemorrhage - diagnosis Postoperative Hemorrhage - epidemiology Postoperative Hemorrhage - prevention & control Postoperative Hemorrhage - therapy Prognosis Retrospective Studies Treatment Outcome Ultrafiltration |
| title | Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes |
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