ABSTRACT
Introduction: The acquired coagulopathy associated with cardiac surgery and cardiopulmonary bypass (CPB) has been associated with increased perioperative transfusion requirements, morbidity, and mortality. As the COVID-19 pandemic put significant strain on blood bank resources, our institution implemented recommendations to utilize prothrombin complex concentrate (PCC) and fibrinogen concentrate to either replace or supplement intraoperative FFP and cryoprecipitate administration, respectively during cardiac surgery. Herein, we describe the transfusion patterns when FFP, cryoprecipitate, PCC, and fibrinogen concentrate are available to the intraoperative care team. Methods: On March 4, 2020, the Division of Cardiothoracic Anesthesia in collaboration with the Department of Cardiac Surgery recommended the use of PCC and Fibryga as first-line therapy for non-surgical coagulopathy based on viscoelastic and static testing and visual inspection of the surgical field in all consecutive cardiac surgical patients older than 18 years having coronary artery bypass grafting (CABG), valve surgery, aortic surgery, heart or lung transplantation, left ventricular assist device (LVAD) placement, or some combination of these procedures. We recommended administering PCC 500 units up to 2000 units, and Fibryga 1 gram up to 4 grams in divided doses until the TEG R-value and alpha angle, respectively returned to normal or bleeding in the surgical field stopped. We collected patient demographic information, clinical variables, and outcomes retrospectively from the electronic medical record. Data are described as means (± SD) and percentages. Results: From March 4, 2020, to October 30, 2020, we analyzed 224 patients. The mean age was 58 years ±14.4 and 79 (35.7%) were women. Three patients were excluded, as they had cardiac surgeries without CPB. The majority of patients had CABG and/or valve surgery;29 (13.1%) patients had complex surgery, 37 (16.7 %) had heart or lung transplantation surgery, and 26 (11.7%) an LVAD placed. One hundred and eighteen (53.3%) patients received no blood product or concentrate (NP Group), 40 (18%) patients received factor concentrates with or without platelets (FC Group), 33 (14.9%) patients received FC and allogenic blood product (FC+ABP Group), and 30 (13.3%) patients received only APB (ABP Group). There was no meaningful difference in platelet administration or chest tube output between groups. Group 2 patients who received both FC and ABP received more RBCs (Table 1). There was no clinically meaningful difference between the baseline static and viscoelastic test results (Table 2). Conclusion: In this single-academic center experience, we demonstrate that non-surgical coagulopathy can be managed safely and effectively with factor and fibrinogen concentrates, allogeneic blood products, and combinations thereof in consecutive patients undergoing varying complexities of cardiac surgery. Future analysis will focus on stratifying surgical procedures to identify patterns of administration as they relate to operational and clinical outcomes.