Page 60 - ANZCP Gazette May 2023

RESULTS: Data was prospectively collected for prime volume, cell salvage, retrograde autologous priming, acute normovolaemic haemodilution, preoperative hemoglobin (Hb), minimum and maximum Hb on bypass, Hb quality indicator >7g/dl, 4 hour blood loss, transfusions, incident and collaboration reporting for 2007–2021 by site and collectively. We noted not only the incidence of use of these strategies but also the improvement in usage over time, as well as an improvement in blood management outcomes. For example, median nadir bypass Hb in 2010 was 81g/L (IQR 72-90), whilst in 2021 was 95 g/L (IQR 84-105) and prime volume has been reduced from 1610ml in 2010 to 1200ml in 2021.
CONCLUSION: The ANZCPR enables contributing sites to measure compliance, and improvements in compliance, to NSQHS Standard 7. This information guides ongoing quality improvement for patient blood management within and across all sites within the registry.
CONCLUSION: This audit identified compliance and noncompliance with the QI’s included from US guidelines. The addition of these QI’s to our QA program provides potential for improvement of our QA program monitoring our ICS service.
HEART TRANSPLANTATION USING DONATION AFTER CIRCULATORY DEATH (DCD) DONORS - ST VINCENT’S HOSPITAL EXPERIENCE UPDATE
Claudio Soto, Yashutosh Joshi, Sarah Scheuer, Hong Chew, Arjun Iyer, Andrew Dinale, Jonathan Cropper, Adam Roshan, Emmerson Sgammotta, Paul Jansz AND Peter Macdonald
St Vincent's Hospital (Sydney), NSW
Donation after circulatory death is a technique utilising the heart from donors after withdrawal of life support and requires sustained circulatory cessation prior to organ retrieval. Our unit was the first to perform heart transplants utilizing distantly procured hearts from DCD donors in 2014
Hearts were transported back to our hospital using the TransMedics organ care system (OCS) which allows for normothermic reperfusion, assessment and optimization of the donor hearts. Donor criteria include age <55 y.o. with no known history of cardiac disease. Prior to 2018, the time from withdrawal of life support to delivery of preservation fluid was <30 minutes. In 2018 this was revised to commence once systolic arterial pressure is <90 mmHg. Evaluation of organ suitability is determined by metabolic assessment of lactate extraction and reduction in the overall value over time, as well as visual assessment of the heart
To date our unit has performed 72 DCD heart transplants. The average donor age was 32.5 years with LVEF at referral 62%. The average recipient age was 53.5years with LVEF 23%. Median ICU stay was 5 days and hospital stay 17.5 days. The average time on the OCS was 279.4 +/- 57.2 minutes. The 30 day survival was 97% with one early death secondary to complications from severe primary graft dysfunction
The application of ex-vivo perfusion to donor heart procurement has transformed cardiac transplantation by facilitating the use of a previously non-utilized source of donors, contributing to a 24% increase in heart transplant activity at our institution. Early and mid-term outcomes with DCD donors are comparable to those of traditional brain dead donors with 91% (86%) and 87% (81%) 1 and 5 year survival respectively
AN AUDIT
INTRAOPERATIVE CELL SALVAGE AT FLINDERS MEDICAL CENTRE
Aidan Singh Howard AND Annette Mazzone
Flinders Medical Centre, South Australia
PURPOSE: The National Blood Authority recommends a quality assurance program is attached to intraoperative cell salvage (ICS) use but does not define quality indicators (QI) for benchmarking. Guidelines in the USA provide QI values for haemoglobin (Hb > 15g/dL), plasma free haemoglobin (PFHb < 0.1g/L) and heparin concentrations (< 0.5 IU/mL) for processed blood. Our current QA program records volume and haematocrit of processed blood determined by the ICS systems. This audit evaluated the potential for improvement of our QA program by including additional benchmarks for processed blood quality.
METHODS: Blood samples were taken from the ICS collection reservoir pre-processing, the re-infusion bag pre high blood flow filter and re-infusion bag post-filter prior to delivery to the patient in 9 cardiac surgical procedures utilising cardiopulmonary bypass. Samples were analysed for Hb measurement, PFHb levels and heparin activity as determined by anti-Xa assay.
RESULTS: Haemoglobin content achieved the QI in 8/9 cases, (average concentration: 17.7 g/dL and 17.6 g/dL pre- and post-filter respectively). ICS device haematocrit underestimated Hb in 8/9 cases (average 53.4%), achieving QI in 6/9 cases. Plasma free Hb levels achieved the QI in 5/9 cases (average: 1.2g/L). Heparin concentrations achieved the QI for 8/9 cases (average 0.36 IU/mL and 0.31 IU/mL pre- and post- filter respectively).
ON THE
QUALITY OF
57 MAY 2023 | www.anzcp.org