Introduction: Blood product administration in cardiac surgical patients has been implicated in postoperative mortality, morbidity (prolonged ventilation, renal dysfunction, infection) and longer ICU stay. However, intraoperative bleeding often necessitates resuscitation with blood products (packed red blood cells, cryoprecipitate, plasma, and platelets). We sought to evaluate if intraoperative blood transfusion during cardiac surgery was associated with prolonged ventilation in the post operative period. Methods: We accessed the Society of Thoracic Surgeons Adult Cardiac Surgery Database at our institution (urban academic hospital). Inclusion criteria were adult patients undergoing any open chest cardiac operation. Exclusion criteria were any post operative blood transfusion as we sought to isolate the effect of intraoperative blood transfusion. The logistic model assessed for relatedness of postoperative events (anticoagulation related bleeding, atrial fibrillation, cardiac arrest, gastrointestinal events, prolonged ventilation, pulmonary thromboembolism, renal failure, stroke, and survival at 30 days) to blood product use in the operating room as a function of each blood product. Results: 503 patients were included in the analysis. 93 patients were transfused intraoperatively (18.5%). There was no association of intraoperative fresh frozen plasma and cryoprecipitate use with postoperative complications. There was no association of packed red blood cell administration intraoperatively and prolonged ventilation. We found a strong positive association between platelet transfusion and prolonged ventilation. The odds of prolonged ventilation increased significantly as the number of platelet units administered post heparin reversal increased (p value = 0.015, CI = 1.07-2.22, odds ratio = 1.54). Conclusions: Intraoperative platelet administration in cardiac surgery patients was linked to prolonged ventilation. Platelet transfusions are often necessitated by bleeding and platelet lysis during cardiopulmonary bypass. The relationship between intraoperative platelet administration and prolonged mechanical ventilation is influenced by the severity of patient comorbidities, surgery complexity and cardiopulmonary bypass time amongst other factors.
Shaykhinurov et al. (Sun,) studied this question.