• Megan Lanigan, Daniel Siers, Megan Schramski, Andrew Shaffer, Ranjit John, Ryan Knoper, Stephen Huddleston, Lauren Gunn-Sandell, Alexander Kaizer, and Tjorvi E Perry.
• Department of Anesthesiology, University of Minnesota, Minneapolis, MN. Electronic address: mlanigan@umn.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 May 1; 38 (5): 113511431135-1143.

ObjectiveTo demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce non-RBC product administration in adult cardiac surgical patients.DesignA prospective observational study.SettingAt a quaternary academic teaching hospital.ParticipantsCardiac surgical patients.InterventionsViscoelastic-based intraoperative transfusion algorithm.Measurements And Main ResultsThe study authors compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historic controls after implementing a viscoelastic-based algorithm. The authors found a non-significant reduction in transfusion of 23.8% for fresh frozen plasma (FFP) units (0.84 ± 1.4 v 0.64 ± 1.38; p = ns), 33.4% for platelet units (0.90 ± 1.39 v 0.60 ± 131; p = ns), and 15.8% for cryoprecipitate units (0.19 ± 0.54 v 0.16 ± 0.50; p = ns). They found a 43.9% reduction in red blood cell (RBC) units transfused (1.98 ± 2.24 v 0.55 ± 1.36; p = 0.008). There were no statistically significant differences in time to extubation (8.0 hours (4.0-21.0) v 8.0 (4.0-22.3), reoperation for bleeding (15 [12.3%] v 10 [10.6%]), intensive care unit length of stay (ICU LOS) (51.0 hours [28.0-100.5] v 53.5 [33.3-99.0]) or hospital LOS (9.0 days [6.0-15.0] v 10.0 [7.0-17.0]). Deviation from algorithm adherence was 32.7% (48/147). Packed RBC, FFP, platelets, cryoprecipitate, and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with historic controls, whereas times to extubation, ICU LOS, and hospital LOS did not reach significance.ConclusionsAfter the implementation of a viscoelastic-based algorithm, patients received fewer packed RBC, FFP, platelets, cryoprecipitate, and cell saver. Algorithm-compliant patients received fewer transfusions; however, reductions in times to extubation, ICU LOS, and hospital LOS were not statistically significant compared with historic controls.Copyright © 2024 Elsevier Inc. All rights reserved.

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