Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes.

Perioperative transfusion of blood products is associated with increased morbidity after cardiac surgery, including prolonged mechanical ventilation, prolonged hospital length of stay, transfusion-related acute lung injury, increased incidence of infection, acute kidney injury, and mortality (1–5). Even with a trend toward minimizing the volume of cardiopulmonary bypass (CPB) circuits, priming volumes may still represent a significant percentage of a neonate’s and infant’s circulating blood volume. The resultant hemodilution may lead to reduction of platelet and coagulation factor concentrations, which along with CPB-induced platelet dysfunction and coagulopathy, may contribute to persistent postoperative bleeding requiring significant blood product administration and its associated increased risk of complications. A multidisciplinary approach to perioperative blood product management has been endorsed as best practice by the Society of Thoracic Surgeons (STS) in adult patients to minimize high transfusion rates associated with cardiovascular surgery (6). Adoption of perioperative transfusion algorithms may decrease blood product utilization after pediatric cardiac surgery and improve clinical outcomes (7,8). This study represents analysis of a multidisciplinary quality improvement (QI) project aimed at decreasing perioperative blood product administration and bleeding complications at our institution.