Targeted Bleeding Management Reduces the Requirement for Blood Component Therapy in Lung Transplant Recipients

TY - JOUR

T1 - Targeted Bleeding Management Reduces the Requirement for Blood Component Therapy in Lung Transplant Recipients

AU - Smith, I.

AU - Pearse, B.

AU - Faulke, D.

AU - Naidoo, R.

AU - Nicotra, L.

AU - Hopkins, P.

AU - Ryan, E.

PY - 2016/6/27

Y1 - 2016/6/27

N2 - Objective Lung transplantation is associated with high rates of bleeding and frequent blood transfusion. We aimed to determine if point of care coagulation testing reduced transfusion requirements. Design, Settings and Participants A before-and-after cohort analysis conducted at a single tertiary referral centre. Ninety-three sequential adult patients between January 2010 and January 2014 undergoing isolated lung transplant without preoperative extracorporeal support were analysed. Intervention ROTEM and Multiplate point of care coagulation testing was introduced on July 1st 2012 with an associated algorithm based on the results. Measurements and main results Statistically significant decreases in the proportion of patients receiving PRBCs (87% vs. 65%; p=0.015), FFP (72% vs. 30%; p<0.0001) and platelets (70% vs. 37%; p=0.002) were found after the intervention. There were small decreases in median chest tube blood loss at two hours (300mls vs. 215mls; p= 0.03) and four hours (440mls vs. 350mls; p= 0.050) but not at twelve hours postoperatively. There were no changes in re-operation for bleeding (9% vs. 4%; p=0.158) or in-hospital mortality (6% vs. 2%; p=0.617). The cost of blood products administered decreased from a median of $3935 to $991 (p<0.001). Conclusion Use of point-of-care coagulation testing in lung transplant surgery is associated with a significant reduction in blood product use and cost. There were no detectable changes in outcome asides from a small decrease in early postoperative bleeding.

AB - Objective Lung transplantation is associated with high rates of bleeding and frequent blood transfusion. We aimed to determine if point of care coagulation testing reduced transfusion requirements. Design, Settings and Participants A before-and-after cohort analysis conducted at a single tertiary referral centre. Ninety-three sequential adult patients between January 2010 and January 2014 undergoing isolated lung transplant without preoperative extracorporeal support were analysed. Intervention ROTEM and Multiplate point of care coagulation testing was introduced on July 1st 2012 with an associated algorithm based on the results. Measurements and main results Statistically significant decreases in the proportion of patients receiving PRBCs (87% vs. 65%; p=0.015), FFP (72% vs. 30%; p<0.0001) and platelets (70% vs. 37%; p=0.002) were found after the intervention. There were small decreases in median chest tube blood loss at two hours (300mls vs. 215mls; p= 0.03) and four hours (440mls vs. 350mls; p= 0.050) but not at twelve hours postoperatively. There were no changes in re-operation for bleeding (9% vs. 4%; p=0.158) or in-hospital mortality (6% vs. 2%; p=0.617). The cost of blood products administered decreased from a median of $3935 to $991 (p<0.001). Conclusion Use of point-of-care coagulation testing in lung transplant surgery is associated with a significant reduction in blood product use and cost. There were no detectable changes in outcome asides from a small decrease in early postoperative bleeding.

KW - Lung transplantation

U2 - http://dx.doi.org/10.1053/j.jvca.2016.06.027

DO - http://dx.doi.org/10.1053/j.jvca.2016.06.027

M3 - Article

SN - 1053-0770

SP - -

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

ER -