Loosely modelled on the CBC-TV reality show, the cardiac centre’s innovation committee in 2012 awarded $150,000 in philanthropic funds to a blood-saving experiment pitched by Keyvan Karkouti and his colleagues. Their goal was to adopt a point-of-care testing system that some European hospitals had used to better predict what kind of blood product a patient might need at the end of a major surgery, when it is tricky to assess which patients will not clot well and why.
Some need platelets, others plasma or other blood products. If doctors give the wrong one, the patient won’t suffer serious problems, but the blood product will have been wasted.
“There’s risks associated with blood transfusions, even though they’re small,” said Barry Rubin, medical director of Toronto’s Peter Munk Cardiac Centre. “Now, rather than just making a decision in the operating room based on, ‘Hmmm, I think that there’s a significant amount of blood, we should do something in terms of transfusing,’ now we actually have a process in place. By following the process, that allows you to make clinical decisions in a much more rigorous way.”
On the day of Mr. Towns’s procedure, a nurse withdrew a vial of his blood from the heart-lung machine toward the end of the surgery, then walked it down the hall to a lab containing two machines that insert a rod into the vial and spin it to see how quickly clotting begins in the blood sample.
A graph crawled across the screen, which Dr. Karkouti interpreted to mean that Mr. Towns was unlikely to bleed enough to require a transfusion of any kind.
After restarting Mr. Towns’s heart and unhooking him from the heart-lung machine, the surgeons packed his heart with two sponges and observed a “five-minute rule,” an aspect of the new regime that helps the surgical team assess just how much the patient is bleeding.
When five minutes had elapsed, the sponges were placed on a scale. If they weighed more than 60 grams, it could be a sign the patient would bleed more than expected. The sponges weighed 83 grams.
Rather than rush to transfuse, the surgical team waited a few more minutes, reassured by the earlier test results. Mr. Towns’s bleeding soon stopped on its own and the surgical team closed his chest. No transfusion necessary.
The pilot project, which began with cardiac surgeries in January of 2013, has now been expanded to lung and liver transplants at Toronto General Hospital, which is part of the University Health Network. The work is now funded permanently by the hospital.
Dr. Karkouti and his colleagues, meantime, have received a grant to run a formal clinical trial of the regime at 12 hospitals, which is set to begin in September.
“I don’t think that there’s a better strategy than what we’ve done here because the blood that you save, that you end up not having to transfuse during cardiac surgery cases and now during lung transplants and liver transplants, which by their very nature are significant blood loss cases, occasionally, that blood is now available for somebody else to use,” Dr. Rubin said.
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