The variability of transfusion practice in coronary artery bypass surgery

Article Abstract:

Coronary artery bypass graft (CABG) surgery is an operation to provide an alternate route of blood flow to the heart when the normal blood flow is decreased or blocked off. In CABG, a portion of a healthy blood vessel, usually a vein, is grafted or to the coronary artery that supplies the heart, bypassing the diseased portion of the vessel. Most of the 250,000 patients who undergo CABG surgery each year receive blood transfusions, and account for 10 percent of the 3.2 million yearly recipients of red blood cell transfusions. Some complications of transfusions include infection with cytomegalovirus; the development of transfusion-related non-A non-B hepatitis; and pulmonary edema (the accumulation of water in the lungs). The risk of developing retrovirus infection or graft-vs-host disease following blood transfusion has stimulated additional concern about the use of blood components during surgery. This may be particularly important in heart surgery because of the medical risks of the patient population, the nature of the procedure, and the large amount of blood components that are transfused. Variability in transfusions among institutions and factors that account for this variability were assessed by evaluating 540 patients who underwent CABG surgery at 1 of 18 different institutions. Each patient was given an average of 2.9 units of red blood cells, although the values ranged from 0.4 to 6.3 units in different institutions. Plasma was transfused into 177 patients, and transfusion rates ranged from 0 to 97 percent, depending on the institution. Platelets, a type blood cell involved in coagulation and hemostasis, were transfused into 119 patients; rates of platelet transfusion ranged from 0 to 80 percent, depending on the hospital. These findings show that the use of blood components for CABG surgery varies considerably among institutions. This variability may result from unnecessary transfusions in routine, uncomplicated CABG surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

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To treat the patient or to treat the surgeon

Article Abstract:

Although the availability, testing, and metabolic condition of blood has improved, blood transfusions are still associated with significant hazards. A recent study in the January 2, 1991 issue of the Journal of the American Medical Association reviewed the blood transfusion practices of 18 teaching hospitals involving 540 patients who underwent coronary artery bypass graft (CABG) surgery. The findings of the study showed that the use of blood components was not optimal. Blood use varied widely, indicating that concern was focused more on criteria for transfusion rather than on the patient's needs. The prothrombin time or partial thromboplastin time, which are measures of bleeding, did not appear to influence the decision to use of fresh-frozen plasma. In addition, most patients received two units or less of fresh-frozen plasma, a dose that is ineffective in treating bleeding disorders. The presence of risk factors for bleeding did not appear to influence decisions concerning the transfusion of platelets, a type of blood cell involved in blood clotting. The frequency of blood transfusion appeared to be related to the amount of blood components used; institutions that had more blood transfusions also used greater numbers of blood components. Autologous blood, which is donated by a patient, stored, and later used by the same patient, was employed more frequently by institutions with fewer blood products. The institution appeared to influence decisions concerning blood transfusion. Most studies recommend against the use of blood components to prevent bleeding in heart surgery patients, even when risk factors are present. Because of the hazards of infections associated with blood transfusion, blood and blood products should only be given when necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood products

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Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery: a randomized, double-blind, placebo-controlled trial

Article Abstract:

Intravenous administration of triiodothyronine (T3) does not appear to significantly improve heart muscle function following coronary artery bypass graft (CABG) surgery, though it does appear to prevent decreases in blood levels of thyroid hormone. T3 levels typically drop after CABG surgery, which is often followed by dysfunction of the heart muscle. Among 205 patients having CABG surgery, 66 received T3, 68 received dopamine, and 71 received a placebo. The drugs or placebo were administered intravenously for six hours, starting during the surgery. T3 blood levels dropped before drug administration in all groups and then rose above normal in the group receiving T3. However, T3 administration did not affect hemodynamic factors such as heart rate, blood pressure, and volume of blood pumped per heartbeat. T3 did not affect the need for drugs that improve heart muscle function. Dopamine caused a rise in heart rate and a decrease in need for drugs that improve heart muscle function.

Health aspects, Physiological aspects, Cardiovascular system, Circulatory system, Triiodothyronine

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