Hemostatic therapies and ambiguous abnormal bleeding in cardiac operating rooms: A real-world, case-based evaluation of clinical practices.

OBJECTIVE

Hemostatic therapy is commonly used in cardiac surgery. Despite tools to reduce inappropriate use, variability remains, mainly due to a lack of standards, especially intraoperatively. This study examined practices in cardiac operating rooms using a standardized clinical case.

METHODS

French cardiac anesthesiologists and surgeons responded to a nationwide questionnaire, including a multiple-choice test based on a clinical case of ambiguous bleeding despite normal tests. The use of hemostatic therapies during surgery-reversal, chest closure, and transfer-was assessed with a fictitious surgeon or anesthesiologist involved in the assessment. Interrater reliability was measured using Gwet's AC1, and ratings before and after the intervention were compared with a paired Fisher exact test. Nonclinical factors and perceptions of bleeding were evaluated using a Likert scale.

RESULTS

Interrater reliability was poor among 73 anesthesiologists (γ = 0.38 [95% confidence interval, 0.03 to 0.73]) and 31 surgeons (γ = 0.16 [95% confidence interval, -0.31 to 0.63]). Users' rates significantly increased since chest closure, mainly after the fictitious colleague intervention, regardless of profession (from 29.0% to 89.3% [P < .0001] among surgeons, and from 34.2% to 52.1% [P = .0446] among anesthesiologists). Surgeons reported lower satisfaction and a greater tendency to judge transfusions as insufficient or delayed, possibly due to the greater influence of transfusion policy. There was a trend toward divergence in clotting characteristics ratings with intraoperative bleeding.

CONCLUSIONS

Hemostatic therapy may require standardization to better manage intraoperative bleeding. Teamwork, especially with surgeons, is vital for shared awareness in these complex situations.