OR12-7
Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization
Alexandra Erdmann, MD, The University of Wisconsin–Madison, Monona, WI
Alexandra Erdmann, MD1, Connor Cook, MD2, Michael Wilhelm, MD2, Jenna Torgeson, NP2, Juan Boriosi, MD2 and Luke J. Lamers, M.D., FSCAI3, (1)The University of Wisconsin–Madison, Monona, WI, (2)The University of Wisconsin–Madison, Madison, WI, (3)University of Wisconsin Health, Madison, WI
Keywords: Complications, Congenital Heart Disease (CHD) and Quality
Background
Cardiac catheterization (cath) is essential to manage congenital heart disease (CHD), yet it carries risks. We found our institutional complication rate exceeded the mean for the IMPACT Registry; the most common being red blood cell transfusion (RBCT) within 72 hours. Thus, we implemented a quality improvement project to reduce cath associated RBCT.
Methods
Using PDSA methodology we applied interventions including: 1. Intra-cath practices to reduce hemodilution, blood loss, and excessive anticoagulation, 2. Standardized transfusion guidelines, and 3. “Hard stop” requiring cath team approval prior to elective RBCT. Our primary outcome measure was cases between transfusions (CBT) and length of stay (LOS) was a countermeasure. We compared characteristics of patients who did and did not receive RBCT.
Results
698 pediatric CHD caths occurred from 1/2017-9/2023. Initial interventions and guidelines did not alter CBT, but the “hard stop” prior to RBCT increased CBT (p<0.05; Figure 1) without increasing LOS. Patients requiring RBCT were younger (median 0.31 vs 2.4 years), smaller (5.2 vs 11.8 kg) and had longer procedures (2.24 vs 1.57 hours); all p<0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%;
RR = 4.57, 95% CI: 2.29–10.4; p<0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups (p>0.25).
Conclusions
We implemented a transfusion “hard stop” to successfully increase CBT without increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were associated with RBCT risk.
