An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit

Abstract

Cardiac surgery is estimated to use 20% of the UK blood supply. However, there has been much interest recently in decreasing red cell and blood product use not only to ease strain on blood stocks or avoid potential transmission of infection but also to decrease post-operative transfusion-related complications. Coagulopathies are not uncommon in cardiac surgical patients, but the time lapse for reporting conventional laboratory results has been highlighted as an obstacle to the appropriate use of blood products. Accordingly, much interest has arisen in rapid near-patient testing of coagulation and, in January 2002, a thromboelastometer (ROTEM, Pentapharm, Germany) was purchased for our unit. This audit sought to assess its impact by retrospective analysis of 990 sequential patients' demographic data and transfusion details covering 6 months prior to its introduction and 6 months after. In the 6 months prior to its introduction, red cells were used in 60% of patients and fresh frozen plasma (FFP) and platelets used in 17 and 16% of patients, respectively. In the following 6 months, red cell use had fallen to 53% and FFP and platelets to 12 and 11%, respectively (P < 0.05). Introduction of thromboelastometry has significantly decreased our use of red cells and blood products.