Abstract
Objective: To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions. Design, setting and participants: Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021. Main outcome measures: Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA. Results: Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions. Conclusions: Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.
| Original language | English |
|---|---|
| Pages (from-to) | 193-200 |
| Number of pages | 8 |
| Journal | Critical Care and Resuscitation |
| Volume | 25 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Dec 2023 |
Keywords
- 21 Haematology
- 4 Anaesthesia and Intensive care
- 4.24 Intensive care
- 3 Active
-
Improving patient outcomes through better use of blood products
McQuilten, Z.
1/01/21 → 31/12/25
Project: Research
-
New knowledge and research capacity to improve transfusion outcomes in Australia and internationally
Wood, E.
National Health and Medical Research Council (NHMRC) (Australia)
1/01/20 → 31/12/24
Project: Research
See AlsoPreparing Public Health for Climate ChangeVA Health Care: Additional Assessments of Mileage Reimbursem*nt Data and Veterans' Travel Costs NeededInformed consent in clinical research: Revisiting few concepts and areasShields Helped Implement Program to Bring Infusion Closer to VHA Patients - U.S. Medicine -
Addressing Australia’s national transfusion research priorities
Wood, E., McQuilten, Z., Cameron, P., Cooper, J., Reade, M., Higgins, L., Trotman, J., Stanworth, S., Bielby, L., Coiera, E., Reynolds, J., Mo, A., Flint, A., Sanderson, B. J., Sparrow, R., Harris, A. & French, C. J.
1/01/20 → 31/12/24
Project: Research
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Flint, A. W. J., Brady, K., Wood, E. M., Thao, L. T. P., Hammond, N., Knowles, S., Nangla, C., Reade, M. C., McQuilten, Z. K., & on behalf of The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program (2023). Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study. Critical Care and Resuscitation, 25(4), 193-200. https://doi.org/10.1016/j.ccrj.2023.10.006
Flint, Andrew W.J. ; Brady, Karina ; Wood, Erica M. et al. / Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study. In: Critical Care and Resuscitation. 2023 ; Vol. 25, No. 4. pp. 193-200.
@article{62001a0ed8db4e519d17ea62131b2c6f,
title = "Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study",
abstract = "Objective: To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions. Design, setting and participants: Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021. Main outcome measures: Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA. Results: Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions. Conclusions: Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.",
keywords = "21 Haematology, 4 Anaesthesia and Intensive care, 4.24 Intensive care",
author = "Flint, {Andrew W.J.} and Karina Brady and Wood, {Erica M.} and Thao, {Le Thi Phuong} and Naomi Hammond and Serena Knowles and Conrad Nangla and Reade, {Michael C.} and McQuilten, {Zoe K.} and {on behalf of The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program}",
note = "Funding Information: Site-based contributors are listed in Appendix 1. Andrew Flint is the recipient of an Australian and New Zealand Society of Blood Transfusion (ANZSBT) research grant that contributed to funding this study, along with support from the Australian National Health and Medical Research Council (NHMRC)-funded Blood Synergy (#1189490). Erica Wood is supported by an NHMRC Leadership Fellowship (#1177784), and Zoe McQuilten is supported by an NHMRC Emerging Leadership Fellowship (#1194811). Funding Information: Site-based contributors are listed in Appendix 1. Andrew Flint is the recipient of an Australian and New Zealand Society of Blood Transfusion (ANZSBT) research grant that contributed to funding this study, along with support from the Australian National Health and Medical Research Council (NHMRC)-funded Blood Synergy (#1189490). Erica Wood is supported by an NHMRC Leadership Fellowship (#1177784), and Zoe McQuilten is supported by an NHMRC Emerging Leadership Fellowship (#1194811). This study was undertaken as part of the Point Prevalence Program of ANZICS-CTG and the George Institute for Global Health. This paper has been endorsed by the Point Prevalence Program Steering Committee. Publisher Copyright: {\textcopyright} 2023 The Authors",
year = "2023",
month = dec,
doi = "10.1016/j.ccrj.2023.10.006",
language = "English",
volume = "25",
pages = "193--200",
journal = "Critical Care and Resuscitation",
issn = "1441-2772",
publisher = "Australasian Medical Publishing Co. Pty Ltd. (AMPCo)",
number = "4",
}
Flint, AWJ, Brady, K, Wood, EM, Thao, LTP, Hammond, N, Knowles, S, Nangla, C, Reade, MC, McQuilten, ZK & on behalf of The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program 2023, 'Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study', Critical Care and Resuscitation, vol. 25, no. 4, pp. 193-200. https://doi.org/10.1016/j.ccrj.2023.10.006
Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study. / Flint, Andrew W.J. (Leading Author); Brady, Karina; Wood, Erica M. et al.
In: Critical Care and Resuscitation, Vol. 25, No. 4, 12.2023, p. 193-200.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study
AU - Brady, Karina
AU - Wood, Erica M.
AU - Thao, Le Thi Phuong
AU - Hammond, Naomi
AU - Knowles, Serena
AU - Nangla, Conrad
AU - Reade, Michael C.
AU - on behalf of The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program
A2 - Flint, Andrew W.J.
A2 - McQuilten, Zoe K.
N1 - Funding Information:Site-based contributors are listed in Appendix 1. Andrew Flint is the recipient of an Australian and New Zealand Society of Blood Transfusion (ANZSBT) research grant that contributed to funding this study, along with support from the Australian National Health and Medical Research Council (NHMRC)-funded Blood Synergy (#1189490). Erica Wood is supported by an NHMRC Leadership Fellowship (#1177784), and Zoe McQuilten is supported by an NHMRC Emerging Leadership Fellowship (#1194811). Funding Information:Site-based contributors are listed in Appendix 1. Andrew Flint is the recipient of an Australian and New Zealand Society of Blood Transfusion (ANZSBT) research grant that contributed to funding this study, along with support from the Australian National Health and Medical Research Council (NHMRC)-funded Blood Synergy (#1189490). Erica Wood is supported by an NHMRC Leadership Fellowship (#1177784), and Zoe McQuilten is supported by an NHMRC Emerging Leadership Fellowship (#1194811). This study was undertaken as part of the Point Prevalence Program of ANZICS-CTG and the George Institute for Global Health. This paper has been endorsed by the Point Prevalence Program Steering Committee.Publisher Copyright:© 2023 The Authors
PY - 2023/12
Y1 - 2023/12
N2 - Objective: To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions. Design, setting and participants: Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021. Main outcome measures: Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA. Results: Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions. Conclusions: Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.
AB - Objective: To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions. Design, setting and participants: Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021. Main outcome measures: Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA. Results: Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions. Conclusions: Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.
KW - 21 Haematology
KW - 4 Anaesthesia and Intensive care
KW - 4.24 Intensive care
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U2 - 10.1016/j.ccrj.2023.10.006
DO - 10.1016/j.ccrj.2023.10.006
M3 - Article
C2 - 38234319
AN - SCOPUS:85180283407
SN - 1441-2772
VL - 25
SP - 193
EP - 200
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 4
ER -
Flint AWJ, Brady K, Wood EM, Thao LTP, Hammond N, Knowles S et al. Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study. Critical Care and Resuscitation. 2023 Dec;25(4):193-200. doi: 10.1016/j.ccrj.2023.10.006
