• Taylor Lindgren, Harica Kodakandla, Shelley M Caraway, Krishna B Shah, Xiaofan Huang, Stephanie Opusunju Ibekwe, and Baylor College of Medicine Red Blood Cell Utilization for Cardiac Surgery Working Group.
• Department of Anesthesiology. Baylor College of Medicine, Houston, TX. Electronic address: taylor.lindgren@bcm.edu.
• J. Cardiothorac. Vasc. Anesth. 2023 Oct 1; 37 (10): 194619501946-1950.

ObjectivesA conservative hemoglobin transfusion threshold is noninferior to a liberal threshold in cardiac surgery. However, red blood cell (RBC) transfusion remains common during cardiac surgery. The authors' single-center, retrospective study aimed to decrease RBC transfusions for hemoglobin >7.5 g/dL in nonemergent cardiovascular surgeries utilizing cardiopulmonary bypass (CPB), by educating the anesthesiology and surgical staff on the benefits of a conservative threshold for transfusions, and incorporating the discussion and routine use of blood conservation methods for all nonemergent cardiac surgeries.DesignThis was a single-center, retrospective study that included all nonemergent coronary artery bypass grafting and single-valve cases utilizing CPB from January 2018 to December 2021 before and after the intervention in July 2019.SettingThe data involved a single community hospital.ParticipantsA total of 417 patients were included in the study.InterventionsThe authors adopted a conservative threshold for blood transfusion and implemented a collaborative multidisciplinary approach to blood conservation.Measurements And Main ResultsBaseline patient characteristics were summarized, and the incidence of RBC transfusion before and after the intervention on July 26, 2019, were compared by Wilcoxon rank sum and chi-square tests. Multivariate logistic regression was used. The intervention was significantly associated with reduced RBC transfusion rate after adjusting for confounding variables (p < 0.05). The odds of receiving an RBC transfusion among patients after the intervention was 0.615 times the odds among patients before intervention (95% CI: 0.3913-0.9663).ConclusionsThe authors' goal was to improve patient outcomes and the quality of perioperative care during cardiac surgery. By implementing a protocol and educating anesthesiologists, surgeons, and perfusionists, they successfully decreased the incidence of RBC transfusion above a hemoglobin of 7.5 g/dL.Copyright © 2023 Elsevier Inc. All rights reserved.

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