Background: The effect of restrictive blood transfusion in comparison to liberal red cell transfusion strategy on clinical outcome in cardiac surgery remains undetermined.
Objectives: The aim of this work is to evaluate the restrictive blood transfusion strategy versus the liberal strategy in open heart surgery in terms of vital organ functions (heart, brain, lung, and kidney) and mortality.
Patients and Methods: After approval of Institutional ethical committee and obtaining written informed consent from the patient, in this multicenter randomized prospective study, we assigned 100 adult cardiac surgery patients with Euro score I of 6 or more to a restrictive red cell transfusion trigger (transfuse if hemoglobin level was <7.5g/dl starting from the induction of anesthesia) and liberal red cell transfusion trigger (transfuse if hemoglobin level was <9.5g/dl in the operative room or intensive care unit or <8.5g/dl in the ward). The primary outcome was composite of any cause death, myocardial infarction, stroke, or new onset renal failure with dialysis by discharge from hospital or by day28 whichever came first.
Results: There was a significant decrease in RBC transfusion in the restrictive group intraoperative, in the postoperative day (1), and in the ward stay. There was significantly less fresh frozen plasma transfused in the restrictive group during the ward stay only. There were a significant decrease in ventilator time, ICU stay, chest tube drainage, and rapid AF occurrence in the restrictive.
Conclusion: The restrictive transfusion strategy showed efficacy and safety in decreasing transfusion requirements in cardiac surgery, thus decreasing morbidities and mortality associated with blood transfusion. It also showed cost effectiveness.