Primary Isolated CABG Restrictive Blood Transfusion Protocol Reduces
Transfusions and Length of Stay
Abstract
Background: Cardiac surgeries use 10%–15% of red blood cells
transfused in the United States, despite benefits of limiting
transfusions. We sought to evaluate the the feasibility and impact of a
restrictive transfusion protocol on blood use and clinical outcomes in
patients undergoing isolated primary coronary artery bypass grafting
(CABG). Methods: Blood conservation measures, instituted in 2012,
include preoperative optimization, intraoperative anesthesia and pump
fluid restriction with retrograde autologous priming and vacuum-assisted
drainage, use of aminocaproic acid and cell saver, intra- and
postoperative permissive anemia, and administration of iron and lowdose
vasopressors if needed. Medical records of patients who underwent
isolated primary CABG from 2009–2012 (group A; n=375) and 2013–2016
(group B; n=322) were compared. Results: CABG with grafting to 3 or 4
coronary arteries was performed in 262 (70%) and 222 (69%) patients
and bilateral internal thoracic artery grafting in 202 (54%) and 196
(61%) patients in groups A and B, respectively. Mean preoperative and
intraoperative hematocrit was 40.3% and 40.7%, 28.9% and 29.4% in
groups A and B, respectively. Total blood transfusion was 24% and
6.5%, intraoperative transfusion 10% and 1.2%, postoperative
transfusion 19% and 5.3% (p<0.0001 for all) in groups A and
B, respectively. Median postoperative length of stay was 5.0 days in
group A and 4.5 days in group B (p =.02), with no significant
differences between groups in mortality or morbidity. Conclusions: A
restrictive transfusion protocol reduced blood transfusions and
postoperative length of stay without adversely affecting outcomes
following isolated primary CABG.