Redfern Roberta E, Naimy Gabriel, Kuehne Michael, Fleming Kevin, Bobulski Nathan, Chen John T, Moront Michael G
Research Department, ProMedica Toledo Hospital, Toledo, Ohio.
ProMedica Toledo Hospital, Department of Cardiothoracic Surgery, Toledo, Ohio.
J Extra Corpor Technol. 2020 Jun;52(2):103-111. doi: 10.1182/ject-2000007.
Cardiac surgeries account for approximately 20% of blood use in the United States. Allogeneic transfusion has been associated with increased risk of morbidity and mortality, further justifying the need to reduce blood use. This study aimed at determining whether a point-of-care coagulation test, thromboelastography (TEG), impacted blood product administration and outcomes. Patients undergoing isolated coronary artery bypass grafting (CABG) were retrospectively reviewed before the use of TEG (2008-2009) (n = 640) and after implementation (2011-2012) (n = 458). Blood product use was compared between time frames. Logistic regression and generalized linear models were created to estimate the impact on outcomes including the reoperation rate, mortality, and cost. The mean use of each blood product was significantly reduced in the perioperative period. Overall blood product use was decreased by over 40%. Mediastinal re-exploration of bleeding was significantly reduced with TEG (4.8 vs. 1.5%). Six-month mortality was not impacted in this cohort nor was the readmission rate or hospital length of stay. However, blood cost and patient charges were significantly lower after TEG was introduced. The use of TEG to guide the administration of blood products during isolated CABG significantly affected the amounts and types of products given intra- and perioperatively. This resulted in less chest tube drainage, fewer returns to the operating room, and more accurate diagnosis of coagulopathic status. Cost savings to the patient and institution were appreciated as a consequence of these improved clinical outcomes.
在美国，心脏手术约占用血总量的20%。异体输血与发病率和死亡率增加相关，这进一步说明了减少用血的必要性。本研究旨在确定一种床旁凝血检测——血栓弹力图（TEG）是否会影响血液制品的使用及治疗结果。对接受单纯冠状动脉旁路移植术（CABG）的患者在使用TEG之前（2008 - 2009年）（n = 640）和实施之后（2011 - 2012年）（n = 458）进行回顾性分析。比较两个时间段的血液制品使用情况。建立逻辑回归模型和广义线性模型以评估对包括再次手术率、死亡率和成本等结果的影响。围手术期每种血液制品的平均使用量显著减少。总体血液制品使用量减少了40%以上。使用TEG后，纵隔出血再次探查的情况显著减少（4.8%对1.5%）。该队列患者的6个月死亡率、再入院率和住院时间均未受到影响。然而，引入TEG后血液成本和患者费用显著降低。在单纯CABG手术期间使用TEG指导血液制品的输注显著影响了术中及围手术期所输注制品的数量和类型。这导致胸腔引流减少、返回手术室的次数减少，并且对凝血状态的诊断更加准确。由于这些改善的临床结果，患者和医疗机构都节省了成本。
