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Primary Isolated CABG Restrictive Blood Transfusion Protocol Reduces Transfusions and Length of Stay
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  • Rami Akhrass,
  • Faisal Bakaeen,
  • Zade Akras,
  • Penny Houghtaling,
  • Edward Soltesz,
  • A. Marc Gillinov,
  • Lars Svensson
Rami Akhrass
Cleveland Clinic

Corresponding Author:akhrasr@ccf.org

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Faisal Bakaeen
Cleveland Clinic
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Zade Akras
Cleveland Clinic
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Penny Houghtaling
Cleveland Clinic
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Edward Soltesz
Cleveland Clinic
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A. Marc Gillinov
Cleveland Clinic
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Lars Svensson
Cleveland Clinic
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Abstract

Background: Cardiac surgeries use 10%–15% of red blood cells transfused in the United States, despite benefits of limiting transfusions. We sought to evaluate the the feasibility and impact of a restrictive transfusion protocol on blood use and clinical outcomes in patients undergoing isolated primary coronary artery bypass grafting (CABG). Methods: Blood conservation measures, instituted in 2012, include preoperative optimization, intraoperative anesthesia and pump fluid restriction with retrograde autologous priming and vacuum-assisted drainage, use of aminocaproic acid and cell saver, intra- and postoperative permissive anemia, and administration of iron and lowdose vasopressors if needed. Medical records of patients who underwent isolated primary CABG from 2009–2012 (group A; n=375) and 2013–2016 (group B; n=322) were compared. Results: CABG with grafting to 3 or 4 coronary arteries was performed in 262 (70%) and 222 (69%) patients and bilateral internal thoracic artery grafting in 202 (54%) and 196 (61%) patients in groups A and B, respectively. Mean preoperative and intraoperative hematocrit was 40.3% and 40.7%, 28.9% and 29.4% in groups A and B, respectively. Total blood transfusion was 24% and 6.5%, intraoperative transfusion 10% and 1.2%, postoperative transfusion 19% and 5.3% (p<0.0001 for all) in groups A and B, respectively. Median postoperative length of stay was 5.0 days in group A and 4.5 days in group B (p =.02), with no significant differences between groups in mortality or morbidity. Conclusions: A restrictive transfusion protocol reduced blood transfusions and postoperative length of stay without adversely affecting outcomes following isolated primary CABG.
14 May 2020Submitted to Journal of Cardiac Surgery
16 May 2020Submission Checks Completed
16 May 2020Assigned to Editor
17 May 2020Review(s) Completed, Editorial Evaluation Pending
17 May 2020Editorial Decision: Revise Major
22 May 20201st Revision Received
23 May 2020Submission Checks Completed
23 May 2020Assigned to Editor
23 May 2020Review(s) Completed, Editorial Evaluation Pending
23 May 2020Editorial Decision: Accept
Oct 2020Published in Journal of Cardiac Surgery volume 35 issue 10 on pages 2506-2511. 10.1111/jocs.14718