Impact of multimodal blood-saving strategies on transfusion requirements and morbidity and mortality in cardiac surgery with extracorporeal circulation.

Abstract

Abstract:

Introduction: Cardiac surgery carries a high risk of blood product consumption due to hemodilution and coagulopathy associated with CPB.

Materials and Methods: This was an observational, analytical, and retrospective study of 42 adult patients undergoing cardiac surgery at Clínica Guayaquil (January 2024 - March 2025). Patients were divided into three groups according to the number of blood-sparing strategies applied (Group 1: one strategy; Group 2: two strategies; Group 3: three or more strategies). The techniques included: tubing length reduction, acute normovolemic hemodilution (AVHD), autologous retrograde priming (ARP), blood antegrade refilling (BARF), vacuum-assisted venous drainage (VAVD), cell salvage, and continuous ultrafiltration (CUF).

Results: The application of three or more strategies (Group 3) significantly reduced the transfusion requirement during cardiopulmonary bypass (CPB) (33.3% vs. 83.3% in Group 1; p=0.007). Group 3 also presented a lower risk of mortality (p=0.004) and fewer hours of mechanical ventilation (median 6 hours; p<0.001). There were no significant differences in ICU stay or renal or hepatic function.

Conclusions: A multimodal approach with more than three blood-sparing strategies significantly reduces hemodilution, the need for intraoperative transfusions, the duration of mechanical ventilation, and hospital mortality.

Keywords: Blood conservation, extracorporeal circulation, transfusion, hemodilution, cardiac surgery.