Results
Thirty five patients were identified and Table 1.1 represents
baseline characteristics. The mean patient age was 60 years (SD 48 - 73)
and the majority of the cases were LVAD implants (35%) followed by
heart transplants (31%). Table 1.2 demonstrates outcome
observations for PCC4. Summarizing the outcomes: the mean dose of PCC4
was 2920 units (31.4 units/kilogram). Table 1.3 represents
overall blood product usage of each of the four products, andTable 1.4 represents the same review focusing solely on LVAD and
heart transplant (n = 23). Overall median event rates of fresh frozen
plasma (FFP) and red blood cell (RBC) transfusion were 0 (IQR 0 - 3
units) and 4 (IQR 2-5 units). Overall, 43% and 89% of cases received
at least one unit of FFP and/or RBC, respectively. Additionally, 60% of
all patients received a platelet transfusion (median 1, IQR 0-2 units)
and 37% of all patients received cryoprecipitate (median 0, IQR 0-2
units). When focus was applied to the patients that actually received
any blood product (excluding those who did not), transfusion rates were:
median FFP 3 units (IQR 1-6) and RBC 4 units (IQR 2-5). For LVAD and
heart transplant patients (n = 23) 39% received any FFP, with a median
of 0 (IQR 0-3 units) and 91% received RBC with a median of 4 (IQR 2-5
units). Secondary results (Table 1.2 ) included: a mean chest tube
output of 757 mL for 24 hours after surgery (32 milliliters/hour). There
was one occurrence of right ventricular failure, acute kidney injury
requiring renal replacement therapy (RRT), and veno-arterial ECMO all of
which occurred in the same patient. Reviewing this case, there was high
risk for complications - a redo coronary artery bypass with obesity,
advanced coronary disease, and acutely decompensated heart failure.
Acute kidney injury was attributed to vasopressor use and intravenous
contrast media administration given while evaluating the causes of right
ventricular strain. Additionally, the case was attributed with the one
occurrence of lower extremity venous occlusion that was secondary to
suboptimal placement of a femoral central venous access line. One
patient regressed ultimately to terminal wean, unrelated to surgery or
PCC4; the patient expired as a result of prolonged, advanced heart
failure that was not amenable to advanced therapies beyond
pharmacological inotropes.