Page 24 - ANZCP Gazette AUG 2023

Fig 9b Multisite RAP volume 2021
The comprehensive ANZCPR dataset allows us to extend this kind of detailed review to any of these blood management strategies:
• Use of TEG STS Class 1 level B-R, PBM rec # 16 grade C
• Management of preop anaemic patients PBM rec # 2 grade C, STS Class IIA, level B-R
• Use of smaller circuits for smaller patients
• Monitoring 4-hour blood loss
• Adequate rewarming/ optimising physiological conditions PBM rec # 12 Grade A
• Appropriate use of factor concentrates STS class IIB level B-NR, STS Class 1, level A
• Use of TXA PBM rec # 17 grade A, STS Class 1 level A • Management of preop medications PBM rec # 7 grade C, STS Class 1 level B-NR
• Managing risks: older age, types of surgery, redo’s, JW’s
• Determine the need for blood products: low venous saturations on CPB, low DO2
• Incident reporting
• Use of acute normovolemic haemodilution (ANH) PBM rec #14 grade C, STS Class IIA, level A
Action 7.04 – Introduction of performance indicators.
Action 7.04 also recommends the introduction of performance indicators to assess the impact of the blood management strategies. Has compliance to these blood management strategies been reflected in any improvement in blood management outcomes. Has the quality improvement process had any impact?
The minimum haemoglobin on bypass would be a telling indication of the improvement in minimizing hemodilution on bypass. It would provide evidence that a site has in fact optimized the patient’s own red cell mass as action 7.04 intended.
In Fig 10-12 the minimum haemoglobin on bypass
is graphed in blue. In 2010 the collaborative
average minimum hemoglobin on bypass across the collaborative was 81 g/L, in 2021 it is 95 g/L (Fig 10). A single site can track it’s improvements also (Fig 11). And note in Figure 12, the 2021 multisite values have sites 1 and 3 with the highest hemoglobin on bypass.
Fig 10 Multisite
Fig 11 Single site
Fig 12 Multisite 2021
22 SEPTEMBER 2023 3SCTS SPECIAL EDITION | www.anzcp.org