Blood and coagulation product disposition in the modern era: An international multicenter survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC)

Abstract

Study objective Perioperative transfusion is associated with reduced survival and increased morbidity and mortality. Several studies report wide variation in clinical transfusion practice. However, the influence of simple, practical factors–such as which blood products are available, and when - is often disregarded. We hypothesized that these practical issues are relevant confounders of transfusion decisions. Design Web-based survey. Setting Multi-institutional. Participants Members of the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) society reached by monthly newsletter in November 2020. Interventions No interventions. Measurements Survey responses. Main results The newsletter was opened by 429 members. We collected 51 complete surveys, resulting in a response rate of 11.9%. 72% of participants reported having a local algorithm for the use of blood products and coagulation factors. Latency in the time of blood product delivery / availability and the possibility to store or return unused products were most often reported as having an influence on transfusion practice. For point-of-care test availability, 86% of addressees reported rotational thromboelastometry / -elastography, 76% hemoglobin tests, 24% international normalized ratio (INR) measurement and 22% platelet function testing. Six percent of the respondents did not have access to point-of-care tests. The majority of addressees reported that they were able to obtain more than 10 allogeneic blood products simultaneously (63%). Packed red blood cells were available with a delay of 10–15 min and platelets with a delay of 15–20 min. Conclusions Our survey indicates a wide variability in the logistics of perioperative transfusion practice. The information gained could provide a solid basis for future improvements of the guidelines, but also in local transfusion practices.