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How do we manage cardiopulmonary bypass coagulopathy?
Author(s) -
Welsh Kerry J.,
Nedelcu Elena,
Bai Yu,
Wahed Amer,
Klein Kimberly,
Tint Hlaing,
Gregoric Igor,
Patel Manish,
Kar Biswajit,
Loyalka Pranav,
Nathan Sriram,
Loubser Paul,
Weeks Phillip A.,
Radovancevic Rajko,
Nguyen Andy N.D.
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12751
Subject(s) - thromboelastography , medicine , coagulopathy , hemotherapy , coagulation testing , blood product , cardiopulmonary bypass , hemostasis , coagulation disorder , intensive care medicine , coagulation , surgery , emergency medicine , anesthesia
Background Patients who undergo cardiopulmonary bypass ( CPB ) are at risk for coagulopathy. Suboptimal turnaround time ( TAT ) of laboratory coagulation testing results in empiric administration of blood products to treat massive bleeding. We describe our initiative in establishing the coagulation‐based hemotherapy ( CBH ) service, a clinical pathology consultation service that uses rapid TAT coagulation testing and provides comprehensive assessment of bleeding in patients undergoing CPB . A transfusion algorithm that treats the underlying cause of coagulopathy was developed. Study Design and Methods The coagulation testing menu includes all aspects of coagulopathy with close proximity of the laboratory to the operating room to allow for rapid test results. The hemotherapy pathologist monitors laboratory results at several stages in surgery and uses a comprehensive algorithm to monitor a patient's hemostasis. The optimal number and type of blood products are selected when the patient is taken off CPB . Results The CBH service was consulted for 44 ventricular assist device implants, 30 heart transplants, and 31 other cardiovascular surgeries from M ay 2012 through N ovember 2013. The TAT for laboratory tests was 15 minutes for complete blood count, antithrombin, and coagulation panel and 30 minutes for V erify N ow and thromboelastography, in comparison to 45 to 60 minutes in normal settings. The transfusion algorithms were used with optimal administration of blood components with preliminary data suggestive of reduced blood product usage and better patient outcomes. Conclusion We described the successful introduction of a novel pathology consultation service that uses a rapid TAT coagulation testing menu with transfusion algorithms for improved management of CPB patients.