Conserving Blood in Cardiac Surgery

Conserving blood in cardiac surgery

December 2016

NSW Health Pathology has been working with staff at Royal Prince Alfred Hospital this year to use point of care testing for cardiac surgery patients to improve healthcare but also conserve precious blood supplies.

During cardiac surgery bleeding either indicates that a patient might need more sutures or that they are not clotting properly.

bloodconservationpilotIn the absence of real-time testing available to indicate what exactly is happening doctors would not be able to easily differentiate the cause and would frequently give the patient a transfusion of blood or blood products.

Benefits

  • Having point of care testing available at the patient’s bedside means tests can now be done to pinpoint exactly what is happening during surgery and respond in the way that will best help the patient. Targeting blood transfusion at the identified problem also reduces blood product usage overall and stops bleeding quicker.
  • The technology produces reliable results every time that can be integrated with the patient’s clinical situation.  It gives doctors a complete picture of the patient and greatly improves healthcare.
  • On average, patients undergoing cardiac surgery have a 40-50% chance of requiring a blood transfusion. Having point of care tesing enables the doctor to make the right decision every time and can reduce the transfusion rate by up to 50%.
  • This greatly benefits patients with more rapid correction of bleeding and avoiding transfusion through targeted correction of the bleeding problem. This has flow on benefits to reduction in morbidities associated with bleeding such as kidney failure and wound infection.
  • It also means there are greater amounts of blood stores available for those patients who really need it. Of course all this leads to huge savings in time and money. It is estimated that not transfusing a patient can save on average $25,000 per episode of patient care in cardiac surgery.
  • If a metropolitan hospital doing an average of 500 cardiac surgeries per year can reduce the transfusion rate by 50% this means an annual saving of around $1.5 million.

Outcomes so far

  • Since the pilot began in August 2016, point of care testing has been used in around 150 open heart operations at Royal Prince Alfred Hospital.  The working group running the trial are aiming to extend it to Liverpool Hospital before the end of the year.
  • The testing is also being used pre-surgery to better monitor and care for patients undergoing these complex procedures. Specifically, surgery can be planned at an appropriate time when a patient is on drugs that impair the ability of the body to clot appropriately such as aspirin.
  • The overall goal is to produce a standard approach that can be applied across the NSW Health system.  This will mean a consistent and efficient way to test patients that saves time, money and resources but most importantly improves the lives of those in our care"

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