• Ian Smith, Bronwyn L Pearse, Daniel J Faulke, Rishen Naidoo, Lisa Nicotra, Peter Hopkins, and Elizabeth G Ryan.
• Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Queensland, Australia. Electronic address: ian.smith@health.qld.gov.au.
• J. Cardiothorac. Vasc. Anesth. 2017 Apr 1; 31 (2): 426-433.

ObjectiveLung transplantation is associated with high rates of bleeding and frequent blood transfusion. The authors aimed to determine if point-of-care coagulation testing (POCCT) reduced transfusion requirements.Design, Settings, And ParticipantsA before-and-after cohort analysis conducted at a single tertiary referral center. Ninety-three sequential adult patients between January 2010 and January 2014 undergoing isolated lung transplant without preoperative extracorporeal support were analyzed.InterventionROTEM and multi-plate POCCT were introduced on July 1, 2012, with an associated algorithm based on the results.Measurements And Main ResultsStatistically significant decreases in the proportion of patients receiving PRBCs (87% v 65%; p = 0.015), FFP (72% v 30%; p<0.0001) and platelets (70% v 37%; p = 0.002) were found after the intervention. There were small decreases in median chest tube blood loss at 2 hours (300 mLs v 215 mLs; p = 0.03) and 4 hours (440 mLs v 350 mLs; p = 0.050) but not at 12 hours postoperatively. There were no changes in reoperation for bleeding (9% v 4%; p = 0.158) or in-hospital mortality (6% v 2%; p = 0.617). The cost of blood products administered decreased from a median of $3,935.00 to $991.00 (p<0.001).ConclusionsUse of POCCT in lung-transplant surgery is associated with significant reductions in blood product use and cost. There were no detectable changes in outcome aside from a small decrease in early postoperative bleeding.Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

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