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Enhancing Blood Conservation: Insights from Autotransfusion Practices and Clinical Data

This report reviews clinical practice data surrounding autotransfusion and highlights hospitals that achieve exemplary blood utilization rates. It explores blood conservation practices they adopt, including the influence of extracorporeal circulation (ECC) prime volume on intraoperative red blood cell (RBC) usage. By analyzing comparative data and procedure volumes, the study underscores the potential for cost avoidance through efficient blood management strategies. Key metrics discussed include volume returned by procedure type, association with transfusion rates, and techniques to minimize blood loss and avoid anemia.

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Enhancing Blood Conservation: Insights from Autotransfusion Practices and Clinical Data

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  1. Quality Data Collection and Interpretation from the Masses Tim Dickinson, MS September 9, 2011

  2. Objectives • Review Autotransfusion clinical practice data • Hospitals that achieve remarkable blood utilization rates –what blood conservation practices have they adopted? • Association of ECC prime volume with intraop RBC use

  3. ATS Perfusion CPB & ATS Programs

  4. Autotransfusion

  5. 2011: Published ahead of print

  6. Comparative Data

  7. Procedure Volume by Procedure Type

  8. Volume Returned by Procedure Type

  9. Volume Returned by Type of Orthopedic Procedure

  10. RBC Equivalents by Procedure Type

  11. Potential Cost Avoidance

  12. RBC Unit Equivalents Comparison

  13. Rate of Return by Procedure Type

  14. ATS Device Comparison -Rate

  15. ATS Device Comparison -mLs

  16. Cardiopulmonary Bypass

  17. Perfusion Blood Management Influence MINIMIZE BLOOD LOSS AVOID ANEMIA • Coated ECC • Divert Pericardial Bld. • P.O.C. Lab testing • Rx interventions • PLT Sequestration • Temperature? • Autotransfusion • Reduce ECC Prime - Autologous prime • Ultrafiltration • Microplegia

  18. Other Metrics

  19. ECC Net Prime Volume

  20. Relative Odds of Receiving Packed Red Blood Cells Transfusion p value <0.001 2003;97:958-63

  21. Procedure Volume vs. Prime Volumen=28,200 isolated CABGs 2009-2010

  22. Patient Demographics

  23. Intraop RBC units vs. Prime Volume

  24. Intraop RBC -% vs. Prime Volume

  25. Nadir HCT on CPB vs. Prime Volume

  26. Preop HCT vs. Prime Volume

  27. Nadir HCT on CPB vs. Intraop RBCs

  28. Nadir HCT on CPB vs. Intraop RBC %

  29. Summary • ATS utilization rates vary by type of surgery and cell salvage device • Practice variation exists amongst hospitals achieving exceptional blood utilization results • Incremental decreases in net ECC prime volume is associated with less RBC use

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