OBJECTIVE: To monitor the use of blood products and hemostatic intervention after implementation of thromboelastometry. DESIGN: Observational prospective study using a historic control. SETTING: Single-center university hospital. PARTICIPANTS: Patients undergoing cardiac surgery during 2008 (n = 811) were compared with similar patients in 2009 (n = 865). INTERVENTIONS: Thromboelastometry was implemented in December 2008. Changes in transfusion of blood products and changes in use of recombinant factor VIIa and fibrinogen were studied. MEASUREMENTS AND MAIN RESULTS: Use of blood products was not decreased significantly after implementation of thromboelastometry. However, in patients receiving blood products, the units of red blood cells were decreased significantly (p = 0.04). Regarding hemostatic reagents, the use of recombinant factor VIIa was decreased significantly (p = 0.04), and the use of fibrinogen increased significantly (p < 0.001). Most blood products (>70%) were given to a minority of patients (∼10%) in 2008 and 2009. In 2009, thromboelastometry was performed in 146 patients (17%), and the use of blood products (p < 0.0001), recombinant factor VIIa (p < 0.001), and fibrinogen (p < 0.001) was significantly higher compared with patients in whom thromboelastometry was not performed. CONCLUSIONS: After implementation of thromboelastometry, the use of recombinant factor VIIa was decreased significantly, whereas the use of blood products was not decreased significantly in patients undergoing cardiac surgery. Copyright Â
OBJECTIVE: To monitor the use of blood products and hemostatic intervention after implementation of thromboelastometry. DESIGN: Observational prospective study using a historic control. SETTING: Single-center university hospital. PARTICIPANTS: Patients undergoing cardiac surgery during 2008 (n = 811) were compared with similar patients in 2009 (n = 865). INTERVENTIONS: Thromboelastometry was implemented in December 2008. Changes in transfusion of blood products and changes in use of recombinant factor VIIa and fibrinogen were studied. MEASUREMENTS AND MAIN RESULTS: Use of blood products was not decreased significantly after implementation of thromboelastometry. However, in patients receiving blood products, the units of red blood cells were decreased significantly (p = 0.04). Regarding hemostatic reagents, the use of recombinant factor VIIa was decreased significantly (p = 0.04), and the use of fibrinogen increased significantly (p < 0.001). Most blood products (>70%) were given to a minority of patients (∼10%) in 2008 and 2009. In 2009, thromboelastometry was performed in 146 patients (17%), and the use of blood products (p < 0.0001), recombinant factor VIIa (p < 0.001), and fibrinogen (p < 0.001) was significantly higher compared with patients in whom thromboelastometry was not performed. CONCLUSIONS: After implementation of thromboelastometry, the use of recombinant factor VIIa was decreased significantly, whereas the use of blood products was not decreased significantly in patients undergoing cardiac surgery. Copyright Â
Authors: Kevin Fleming; Roberta E Redfern; Rebekah L March; Nathan Bobulski; Michael Kuehne; John T Chen; Michael Moront Journal: J Extra Corpor Technol Date: 2017-12