The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study

Megan Lanigan; Daniel Siers; Andrew Wilkey; Abdo Barakat; Andrew Shaffer; Ranjit John; Ryan Knoper; Stephen Huddleston; Alexander Kaizer; Tjorvi E Perry

doi:10.1053/j.jvca.2022.03.017

The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study

Megan Lanigan, Daniel Siers, Andrew Wilkey, Abdo Barakat, Andrew Shaffer, Ranjit John, Ryan Knoper, Stephen Huddleston, Alexander Kaizer, Tjorvi E Perry

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

OBJECTIVES: Does point-of-care viscoelastic testing in patients undergoing left ventricular assist device implantation or orthotopic heart transplantation reduce non-red blood cell transfusion or improve postoperative outcomes?

DESIGN: A retrospective observational study.

SETTING: At a single-center tertiary university hospital.

PARTICIPANTS: Patients undergoing left ventricular assist device placement or heart transplantation INTERVENTIONS: The authors implemented a TEG-based transfusion algorithm to reduce non-red cell transfusion rates compared with historical controls.

MEASUREMENTS AND MAIN RESULTS: From May 15, 2019, through March 20, 2020, 68 patients underwent left ventricular assist device placement or heart transplantation. Algorithm adherence was 49.2%. After adjusting for relevant variables, platelet (odds ratio [OR] 0.58 [0.39-0.84]; p = 0.004) and cryoprecipitate (OR 0.37 [0.19-0.72]; p = 0.004) transfusion rates and time to extubation (OR -14.1 [-25.8 to -2.3]; p = 0.020) were significantly reduced compared with historical controls. After adjusting for relevant clinical variables, there was a statistically significant reduction in plasma (median [interquartile range] 0.16 [0.07-0.36], p < 0.001), platelets (0.06 [0.02-0.21], p < 0.001), and cryoprecipitate (0.06 [0.01-0.47], p = 0.007) transfusion rates and time to extubation (-16.95 [-27.20 to -6.71], p = 0.002) compared with historical controls.

CONCLUSIONS: The authors report a statistically significant reduction in transfusion of platelets and cryoprecipitate and time to extubation after adjusting for relevant clinical variables compared with historical controls and a significant reduction in the transfusion of plasma, platelets, and cryoprecipitate and time to extubation in those patients for whom the transfusion algorithm was followed. Their results suggest the importance of implementing transfusion algorithms for patients undergoing heart transplantation and left ventricular assist device placement and of accounting for adherence.

Original language	English (US)
Pages (from-to)	3038-3046
Number of pages	9
Journal	Journal of Cardiothoracic and Vascular Anesthesia
Volume	36
Issue number	8 Pt B
DOIs	https://doi.org/10.1053/j.jvca.2022.03.017
State	Published - Aug 2022

Bibliographical note

Funding Information:
No outside funding was received for research support, departmental funding was the sole source.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

left ventricular assist device
orthotopic heart transplant
point-of-care testing
thromboelastography
transfusion management
Algorithms
Blood Transfusion
Humans
Heart Transplantation
Retrospective Studies
Heart-Assist Devices

PubMed: MeSH publication types

Journal Article
Observational Study

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10.1053/j.jvca.2022.03.017

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Lanigan, M., Siers, D., Wilkey, A., Barakat, A., Shaffer, A., John, R., Knoper, R., Huddleston, S., Kaizer, A., & Perry, T. E. (2022). The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study. Journal of Cardiothoracic and Vascular Anesthesia, 36(8 Pt B), 3038-3046. https://doi.org/10.1053/j.jvca.2022.03.017

The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study. / Lanigan, Megan; Siers, Daniel; Wilkey, Andrew et al.
In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 36, No. 8 Pt B, 08.2022, p. 3038-3046.

Research output: Contribution to journal › Article › peer-review

Lanigan, M, Siers, D, Wilkey, A, Barakat, A, Shaffer, A , John, R, Knoper, R, Huddleston, S, Kaizer, A & Perry, TE 2022, 'The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study', Journal of Cardiothoracic and Vascular Anesthesia, vol. 36, no. 8 Pt B, pp. 3038-3046. https://doi.org/10.1053/j.jvca.2022.03.017

Lanigan M, Siers D, Wilkey A, Barakat A, Shaffer A , John R et al. The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study. Journal of Cardiothoracic and Vascular Anesthesia. 2022 Aug;36(8 Pt B):3038-3046. doi: 10.1053/j.jvca.2022.03.017

Lanigan, Megan ; Siers, Daniel ; Wilkey, Andrew et al. / The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation : A Single-Center Observational Study. In: Journal of Cardiothoracic and Vascular Anesthesia. 2022 ; Vol. 36, No. 8 Pt B. pp. 3038-3046.

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title = "The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study",

abstract = "OBJECTIVES: Does point-of-care viscoelastic testing in patients undergoing left ventricular assist device implantation or orthotopic heart transplantation reduce non-red blood cell transfusion or improve postoperative outcomes?DESIGN: A retrospective observational study.SETTING: At a single-center tertiary university hospital.PARTICIPANTS: Patients undergoing left ventricular assist device placement or heart transplantation INTERVENTIONS: The authors implemented a TEG-based transfusion algorithm to reduce non-red cell transfusion rates compared with historical controls.MEASUREMENTS AND MAIN RESULTS: From May 15, 2019, through March 20, 2020, 68 patients underwent left ventricular assist device placement or heart transplantation. Algorithm adherence was 49.2%. After adjusting for relevant variables, platelet (odds ratio [OR] 0.58 [0.39-0.84]; p = 0.004) and cryoprecipitate (OR 0.37 [0.19-0.72]; p = 0.004) transfusion rates and time to extubation (OR -14.1 [-25.8 to -2.3]; p = 0.020) were significantly reduced compared with historical controls. After adjusting for relevant clinical variables, there was a statistically significant reduction in plasma (median [interquartile range] 0.16 [0.07-0.36], p < 0.001), platelets (0.06 [0.02-0.21], p < 0.001), and cryoprecipitate (0.06 [0.01-0.47], p = 0.007) transfusion rates and time to extubation (-16.95 [-27.20 to -6.71], p = 0.002) compared with historical controls.CONCLUSIONS: The authors report a statistically significant reduction in transfusion of platelets and cryoprecipitate and time to extubation after adjusting for relevant clinical variables compared with historical controls and a significant reduction in the transfusion of plasma, platelets, and cryoprecipitate and time to extubation in those patients for whom the transfusion algorithm was followed. Their results suggest the importance of implementing transfusion algorithms for patients undergoing heart transplantation and left ventricular assist device placement and of accounting for adherence.",

keywords = "left ventricular assist device, orthotopic heart transplant, point-of-care testing, thromboelastography, transfusion management, Algorithms, Blood Transfusion, Humans, Heart Transplantation, Retrospective Studies, Heart-Assist Devices",

author = "Megan Lanigan and Daniel Siers and Andrew Wilkey and Abdo Barakat and Andrew Shaffer and Ranjit John and Ryan Knoper and Stephen Huddleston and Alexander Kaizer and Perry, {Tjorvi E}",

note = "Funding Information: No outside funding was received for research support, departmental funding was the sole source. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = aug,

doi = "10.1053/j.jvca.2022.03.017",

language = "English (US)",

volume = "36",

pages = "3038--3046",

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T1 - The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation

T2 - A Single-Center Observational Study

AU - Lanigan, Megan

AU - Siers, Daniel

AU - Wilkey, Andrew

AU - Barakat, Abdo

AU - Shaffer, Andrew

AU - John, Ranjit

AU - Knoper, Ryan

AU - Huddleston, Stephen

AU - Kaizer, Alexander

AU - Perry, Tjorvi E

PY - 2022/8

Y1 - 2022/8

N2 - OBJECTIVES: Does point-of-care viscoelastic testing in patients undergoing left ventricular assist device implantation or orthotopic heart transplantation reduce non-red blood cell transfusion or improve postoperative outcomes?DESIGN: A retrospective observational study.SETTING: At a single-center tertiary university hospital.PARTICIPANTS: Patients undergoing left ventricular assist device placement or heart transplantation INTERVENTIONS: The authors implemented a TEG-based transfusion algorithm to reduce non-red cell transfusion rates compared with historical controls.MEASUREMENTS AND MAIN RESULTS: From May 15, 2019, through March 20, 2020, 68 patients underwent left ventricular assist device placement or heart transplantation. Algorithm adherence was 49.2%. After adjusting for relevant variables, platelet (odds ratio [OR] 0.58 [0.39-0.84]; p = 0.004) and cryoprecipitate (OR 0.37 [0.19-0.72]; p = 0.004) transfusion rates and time to extubation (OR -14.1 [-25.8 to -2.3]; p = 0.020) were significantly reduced compared with historical controls. After adjusting for relevant clinical variables, there was a statistically significant reduction in plasma (median [interquartile range] 0.16 [0.07-0.36], p < 0.001), platelets (0.06 [0.02-0.21], p < 0.001), and cryoprecipitate (0.06 [0.01-0.47], p = 0.007) transfusion rates and time to extubation (-16.95 [-27.20 to -6.71], p = 0.002) compared with historical controls.CONCLUSIONS: The authors report a statistically significant reduction in transfusion of platelets and cryoprecipitate and time to extubation after adjusting for relevant clinical variables compared with historical controls and a significant reduction in the transfusion of plasma, platelets, and cryoprecipitate and time to extubation in those patients for whom the transfusion algorithm was followed. Their results suggest the importance of implementing transfusion algorithms for patients undergoing heart transplantation and left ventricular assist device placement and of accounting for adherence.

AB - OBJECTIVES: Does point-of-care viscoelastic testing in patients undergoing left ventricular assist device implantation or orthotopic heart transplantation reduce non-red blood cell transfusion or improve postoperative outcomes?DESIGN: A retrospective observational study.SETTING: At a single-center tertiary university hospital.PARTICIPANTS: Patients undergoing left ventricular assist device placement or heart transplantation INTERVENTIONS: The authors implemented a TEG-based transfusion algorithm to reduce non-red cell transfusion rates compared with historical controls.MEASUREMENTS AND MAIN RESULTS: From May 15, 2019, through March 20, 2020, 68 patients underwent left ventricular assist device placement or heart transplantation. Algorithm adherence was 49.2%. After adjusting for relevant variables, platelet (odds ratio [OR] 0.58 [0.39-0.84]; p = 0.004) and cryoprecipitate (OR 0.37 [0.19-0.72]; p = 0.004) transfusion rates and time to extubation (OR -14.1 [-25.8 to -2.3]; p = 0.020) were significantly reduced compared with historical controls. After adjusting for relevant clinical variables, there was a statistically significant reduction in plasma (median [interquartile range] 0.16 [0.07-0.36], p < 0.001), platelets (0.06 [0.02-0.21], p < 0.001), and cryoprecipitate (0.06 [0.01-0.47], p = 0.007) transfusion rates and time to extubation (-16.95 [-27.20 to -6.71], p = 0.002) compared with historical controls.CONCLUSIONS: The authors report a statistically significant reduction in transfusion of platelets and cryoprecipitate and time to extubation after adjusting for relevant clinical variables compared with historical controls and a significant reduction in the transfusion of plasma, platelets, and cryoprecipitate and time to extubation in those patients for whom the transfusion algorithm was followed. Their results suggest the importance of implementing transfusion algorithms for patients undergoing heart transplantation and left ventricular assist device placement and of accounting for adherence.

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KW - orthotopic heart transplant

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KW - thromboelastography

KW - transfusion management

KW - Algorithms

KW - Blood Transfusion

KW - Humans

KW - Heart Transplantation

KW - Retrospective Studies

KW - Heart-Assist Devices

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The Use of a Viscoelastic-Based Transfusion Algorithm Significantly Reduces Non–red Blood Cell Transfusion in Patients Undergoing Left Ventricular Assist Device Placement or Heart Transplantation: A Single-Center Observational Study

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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