engleski

Perioperative monitoring of allogeneic blood transfusion in cardiac surgical patients: massive transfusion.

Background: Massive transfusion is usually defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h, or a corresponding blood loss of more than 1–1.5-fold of the body’s entire blood volume. Hemostatic control resuscitation for massively bleeding patients was introduced in collaboration between the blood bank and the clinicians. Aim: The trigger for red cell transfusion in cardiac surgical patients is hemoglobin (HGB) of 100 g/l or hematocrit (HCT) of 0.30 L/L. The goal of transfusion therapy is to raise the HGB values to the level that satisfies the need to maintain tissue perfusion and oxygenation with the aim to prevent dilution coagulopathy, acidosis, and multiorganic failure. We implemented control resuscitation with preemptive use of platelets and plasma in transfusion. Methods: A total of 406 patients were studied in the intensive care unit (ICU) in 2011 ; 21 (5.17%) male patients were observed (mean age 67.49.86 year). The reference group of patients was divided into two groups, according to the quantity of RBCs received. Group 1 (N = 15) received 5–9 units RBCs ; group 2 (N = 6) received 10 units RBCs. European system for cardiac operative risk evaluation (Euro- SCORE II) was used. Patients abided 6.9 days (7.97) in intensive care unit. Echocardiography was used for heart function evaluation. The left ventricular ejection fraction (LVEF) was 61.1  11.06%. During the 12-month study period, 21 patients were included in the analysis of the use of RBCs, platelet concentrates (PCs), and fresh frozen plasma (FFP) within 24 h. The patients received 176 (9.56%) of 1845 units RBC ; 140 (9.28%) of 1509 units FFP and 191 (7.54%) of 2534 platelet concentrates of a total blood products available for management of acute bleeding in ICU. In all these cases CBC (complete blood count) and conventional coagulation tests – prothrombin time (PT) ; activated partial thromboplastin time (aPTT) and international normalised ratio (INR) – were used to evaluate perioperative bleeding. Conventional laboratory measurements were performed prior to the start of the first transfusion and within 24 h after the first transfusion. Data are presented as mean and standard deviation ; P < 0.05 was considered statistically significant. Patients were monitored prior to surgery and for the first 24 h of transfusion of blood components for creatinine, pH, Ca++, troponin I. Duration of surgery/anesthesia (min) was registered too. Results: GROUP 1 (before/after) transfusion: HGB 92.93 g/l (11.84) / HGB 110.87 g/l (14.70) ; P = 0.001 ; HCT 0.27 L/L (0.03)/HCT 0.33 L/L (0.04) ; P = 0.007 ; PLT 171.47 9 109/l (56.69)/PLT 139.53 9 109/l (44.86) ; P = 0.02. GROUP 2: HGB 108.17 g/l (17.7) / HGB 103.33 g/l  14.1) ; P = 0.85 ; HCT 0.31 L/L (0.05) / HCT 0.31 L/L (0.04) ; P = 0.80 ; PLT 156.67 9 109 L (76.26) / PLT 119.67 9 109 (62.44) ; P = 0.04. The report based on retrospective observation indicates that plasma and platelets should be administered in a 1:1:1 ratio (i.e. equal parts of RBCs, FFP and platelets) to massively bleeding patients. Conclusion: Patients who received massive blood transfusion achieved satisfactory tissue perfusion and oxygenation. With this protocol we prevent dilution coagulopathy and acidosis. This approach is associated with improved survival.

massive transfusion; cardiac surgery

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