Blood use standardization according to risk score on congenital heart surgery

PURPOSE: For the purpose of avoiding excessive blood product preparation before congenital heart surgery, we have compared the units of blood prepared for surgery with the number of units of blood transfused. The patients were divided into subgroups for detailed analysis. MATERİALS AND METHOD: 252 patients younger than 18 years who underwent surgery in our clinic Ege University Heart and Vascular Surgery were included in the study retrospectively. In collaboration with the hospital's blood bank, the blood product preparation, transfusion, and return were gathered. The patients were divided into subgroups according to their age, weight, planned operation, and their risk score (RACHS-1). The amount of blood and blood product ordered before surgery and the transfused during surgery and within the first 24 hours following surgery were documented. RESUILTS: Despite a decrease in weight with increasing RACHS scores, increasing complexity of the operation resulted in an increased amount of ordered packed RBCs. Average volumes of packed RBCs ordered for surgery were 27.7cc/kg (500/18) for RACHS-I, 65.2cc/kg (750/11.5) for RACHS-II, 65.5cc/kg (750/11.8) for RACHS-III, 343.7cc/kg (1375/4) for RACHS-IV, and 517.2cc/kg (1500/2.9) for RACHS-V and above. No difference was observed between the amount of pre-ordered whole blood between RACHS subgroups. The volume of whole blood ordered for surgery were calculated as 26.9cc/kg (485/18) for the RACHS-I subgroup, 47.8cc/kg (550.4/11.5) for the RACHS-II subgroup, 51.8cc/kg (611.4/11.8) fort he RACHS-III subgroup, 150cc/kg (600/4) for the RACHS-IV subgroup, and 374.1cc/kg (1085/2.9) for the RACHS-V and above subgroup. In the RACHS-V and above subgroup, more whole blood units were ordered by a magnitude of 13.8 times. More platelets and less FFP were transfused for the RACHS-V subgroup. Average volumes of FFPs transfused were 11.1cc/kg for RACHS-I subgroup,15.6cc/kg for RACHS-II subgroup, 16.9cc/kg for the RACHS-III subgroup, 50cc/kg for the RACHS-IV subgroup, and 17.2cc/kg for the RACHS-V and above subgroup. We have found that ordered amount of blood and blood products were approximately 4 times the amount of blood and blood products transfused during surgery and within the first 24 hours following surgery. CONCLUSİON: Blood transfusion is highly dependent on patient characteristics, diagnosis, weight, and planned operation in congnital heart surgery. The complexity of the variables affecting necessary blood transfusion reflects to the clinical practice as an excessive amount of ordered blood products. Such excessive blood and blood order product, in turn, causes a delay in the availability of any demanded blood or having unused blood. As it is, the process causes unnecessary workload on the blood bank, decrease reserves, and hampers blood product availability in an emergent setting. Blood and blood product orders are can be predicted based on patient characteristics and risk scores in order to avoid excessive blood orders. Keywords: Congenital open heart surgery, RACHS-I, blood transfusion, whole blood, packed red blood cells, cardiopulmonary bypass.