Ongoing Variability in Transfusion Practices in Cardiac Surgery Despite Established Guidelines.

Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, the international evolution of standards remains unknown. Therefore, the objective of this study was to compare the perioperative transfusion of blood components in patients undergoing coronary artery bypass graft (CABG) surgery in different countries. Transfusion practice was investigated prospectively among 16 countries (70 centers). Five-thousand sixty-five (5,065) randomly selected cardiac surgery patients in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells, fresh frozen plasma, and platelets was assessed by day, prior to, during and after surgery until hospital discharge. Intraoperative red blood cell (RBC) transfusion varied from 9 percent to 100 percent among the 16 countries, and 25 percent to 87 percent postoperatively (percent of transfused patients). Similarly, transfusion of fresh frozen plasma (FFP) varied from 0 percent to 98 percent intraoperatively and 3 percent to 95 percent postoperatively, and platelet (PL) transfusion from 0 percent to 51 percent and 0 percent to 39 percent, respectively. An analysis of the EuroSCORE (an internationally validated risk evaluation system for cardiac surgery) risk indices of the countries with the highest and lowest frequencies of use or amounts of each of type blood product failed to demonstrate a correlation between EuroSCOREs and maximum vs minimum frequency of use or amount of blood product administered. Establishment of international guidelines for utilization of blood products in CABG surgery appears necessary.