• Pedro Gabriel Melo de Barros E Silva, Dimas Tadahiro Ikeoka, Viviane Aparecida Fernandes, Nilza Sandra Lasta, Debora Prudencio E Silva, Mariana Yumi Okada, Beatriz Akinaga Izidoro, José Carlos Teixeira Garcia, Antonio Claudio do Amaral Baruzzi, and Valter Furlan.
• Einstein (Sao Paulo). 2013 Jul 1; 11 (3): 310-6.

ObjectiveCardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery.MethodsBetween April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of ε-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence.ResultsAfter three months of protocol implementation, the use of ε-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol.ConclusionThe rational use of blood products associated with infusion of ε-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.

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