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Striving for Transfusion-Free Open Cranial Vault Remodeling: A Novel Protocol
David E. Kurlander, MD
Mona Ascha, BS
Danielle Marshall, BS
Derek Wang, BS
Mustafa Ascha, MS
Paul A. Tripi, MD
Hollie M. Reeves, DO
Katharine A. Downes, MD
Sanjay Ahuja, MD
Alexandre T. Rotta, MD
Krystal Tomei, MD, MPH
Gregory E. Lakin, MD
Case Western Reserve University
2017-02-02
Presenter: David E. Kurlander, MD
Affidavit:
Agreed.
Director Name: Devra Becker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Patients undergoing cranial vault remodeling for craniosynostosis frequently experience high blood loss and require blood transfusion. We have developed a novel blood conservation protocol.
Methods: Forty-four consecutive patients undergoing open cranial vault remodeling were retrospectively reviewed. Early in the series, aminocaproic acid (ACA) use depended on anesthesiologist preference, and no patients received erythropoietin (EPO). After protocol initiation, all patients were evaluated for preoperative EPO and received intraoperative ACA. Cell saver device was used when possible. Estimated blood loss (EBL) and allogeneic transfusion volume were studied using Tukey's Test comparing the ACA+EPO Group, ACA Only Group, and No ACA Group.
Results: ACA+EPO Group (N=11) had mean EBL 11.1cc/kg and transfusion volume 2.1cc/kg. This includes 8 patients (73%) not requiring transfusion intraoperatively, 6 (55%) not requiring transfusion during hospitalization, and 1 (9%) who used cell saver. ACA Only Group (N=17) had mean EBL 22.8cc/kg and transfusion volume 20.2cc/kg. This includes 5 patients (29%) not requiring transfusion intraoperatively, 3 (18%) not requiring transfusion during hospitalization, and 2 (12%) who used cell saver. No ACA Group (N=16) had mean EBL 46.2cc/kg and transfusion volume 48.0cc/kg. This includes 1 patient (6%) not requiring transfusion intraoperatively who did receive transfusion postoperatively, and 3 (19%) who used cell saver. ACA+EPO Group had significantly lower EBL and transfusion requirement compared to No ACA Group (p<0.05), but significance was not achieved compared to ACA Only Group (p=0.29)
Conclusion: In patients undergoing open cranial vault remodeling, preoperative EPO and intraoperative ACA can decrease EBL and oftentimes eliminate transfusion requirement.
