Compliance with ESAIC guidelines for fibrinogen concentrate prescription in cardiac surgery: a multicentre French cohort study.

BACKGROUND

Fibrinogen concentrate may reduce allogeneic blood product transfusion in cardiac surgery patients with bleeding associated with acquired hypofibrinogenemia. The European Society of Anaesthesiology and Intensive Care (ESAIC) has issued guidelines, but compliance to these guidelines has not been studied yet.

METHODS

This multicentre observational cohort study was aimed at evaluating the compliance of fibrinogen prescription with ESAIC. Adult patients undergoing cardiac surgery with cardiopulmonary bypass in 13 French cardiac surgery centres were recruited from March 2017 to April 2018. Compliance with ESAIC guidelines was considered whenever patients received fibrinogen in case of hypofibrinogenemia and clinically relevant bleeding, or when patients did not receive fibrinogen concentrate if there was no hypofibrinogenemia and/or no clinically relevant bleeding. The primary endpoint was the percentage of patients who complied those guidelines. Secondary endpoints were to assess the consequences of non-compliance on in-hospital deaths and hospital length-of-stay.

RESULTS

Among 2,649 adult patients undergoing cardiac surgery with cardiopulmonary bypass, 374 (14.1%) received fibrinogen concentrate. Rates of prescription among centres varied from < 1.0% to 31.2% (p < 0.001). Compliance with guidelines was observed in 2,291 (86.5%) patients, driven by a high number of patients without prescription (N = 2,158; 94.5%). In non-compliance patients (N = 358; 13.5%), fibrinogen over-prescription (N = 241) exceeded under-prescription (N = 117). In multivariate analyses, non-compliance with the guidelines was not significantly associated with in-hospital deaths or hospital stay.

CONCLUSIONS

Fibrinogen concentrate prescription varied significantly among centres but compliance with the ESAIC guidelines was high (86.5%). Non-compliance (13.5%)-mostly due to over-prescription-was not associated with adverse outcomes.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: (NCT03075774).