Introduction of a simple algorithm improves thromboelastography-guided blood product use during cardiac surgery

Blood products are recognised as an expensive commodity and their use is associated with significant patient risk1. Blood product use in cardiac surgical patients has been shown to vary widely between institutions suggesting that some transfusions may be unnecessary2. Determining the cause of bleeding (surgical or coagulopathy or both) in a timely manner remains challenging. Viscoelastic point-of-care testing has been used in cardiac surgery to assist clinicians to determine the cause of ongoing bleeding (surgical versus coagulopathic), correctly treat coagulopathy, and to monitor whether the treatment has been effective.

We have been using thromboelastography (TEG) during cardiac surgery in our institution for some time. We recently introduced a simple algorithm in an attempt to improve our TEG-guided blood product use. We conducted audits before and after introduction of this algorithm. We present a comparison of these two audits, representing blood product use pre- and post-introduction of this simple TEG-based algorithm (Figure 1).

Data were prospectively collected for a pre-algorithm period of 12 months (598 patients) and a post-algorithm period of six months (306 patients) and compared. Patient demographics (age, sex, EuroSCORE II, bypass time, type of surgery) were...