Impact of Pre-bypass Autologous Blood Collection on Blood Transfusion Rates.

Pre-bypass acute autologous donation (PAAD) is a method of blood conservation that reduces exposure of blood to the cardiopulmonary bypass (CPB) circuit and may prevent the contact activation of platelets and clotting factors. The purpose of this study was to evaluate the impact of PAAD on product transfusion rates in cardiac surgical patients. This is a retrospective study of patients undergoing cardiac surgery between 2015 and 2017 for either a coronary artery bypass (CABG), valve replacement, or a combined valve/CABG procedure. PAAD was performed by removing blood from the venous line of the bypass circuit immediately before the institution of CPB. The amount of PAAD volume was determined during the surgical time-out. This was based on patient size, baseline hemoglobin, and type of case. Poisson logistic regression was used to determine whether PAAD was a significant predictor for blood product transfusion. After obtaining institutional review board approval, we reviewed 236 records on (n = 154, 65.3%) who received PAAD and (n = 82, 34.7%) with no blood withdrawal before CPB. The median PAAD volume in the PAAD group was 750 mL. Patients undergoing PAAD had a 14.3% red blood cell (RBC) transfusion rate (.27 ± .91 units), and without PAAD, the RBC transfusion rate was 62.2% (1.56 ± 1.79 units). The significant (p < .05) odds ratios (ORs) for RBC transfusion were as follows: baseline hemoglobin .617 (.530-.719), PAAD .998 (.997-.999), CPB time 1.009 (1.003-1.015), age 1.034 (1.013-1.055), and BSA odds ratio (OR) .326 (.124-.857). PAAD could not be used in all patients. However, using the OR in the Poisson logistic regression model, a one-unit reduction in RBC transfusion is predicted for each 500 mL of PAAD. PAAD was also associated with a significant reduction in fresh frozen plasma and platelet transfusion.

Perfusion Measures and Outcomes (PERForm) registry: First annual report.

BACKGROUND: The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. METHODS: This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. RESULTS: A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). CONCLUSION: Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.