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The heart of the matter

Device at Rogue Regional Medical Center cuts down on amount of blood used during open heart surgery
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Medical technician Sharon Elsmore uses a Thrombelastograph Hemostasis Analyzer at Rogue Regional Medical Center. The analyzer monitors how well a patientís blood is clotting and allows surgeons to reduce the amount of blood used, shortening hospital stays and reducing mortality rates. Jamie Lusch / Daily TidingsJamie Lusch
 Posted: 2:00 AM March 28, 2013

The days of a heart-surgery patient leaving the hospital pumped full of someone else's blood are over at Rogue Regional Medical Center.

The Medford hospital has spearheaded a push to cut down on the amount of blood transfusions it doles out during open-heart surgeries.

To do this, technicians are using a device called a Thrombelastograph Hemostasis Analyzer, known as a TEG for short. The test gives heart surgeons a real-time view of what's happening with a patient's blood as he or she lies on the operating table.

"We're on a big campaign to reduce the amount of blood we use," said Dr. Charles Carmeci of Asante Cardiovascular and Thoracic Surgeons. Asante Health System owns RRMC and is in the process of buying Ashland Community Hospital.

"We do not give a patient any more blood than we absolutely have to," he said.

The campaign has its roots in the hospital's dealings with Jehovah's Witness patients. Their religion bars them from receiving blood transfusions.

Doctors who performed heart surgeries on Jehovah's Witnesses were forced to make do without the transfusions. It provided a good training ground for the new policy, he said.

"Working on the Jehovah's Witnesses helped us push the envelope on what we could do," Carmeci said.

Then along came data that suggested blood transfusions were hard on the body, leading to increased mortality rates for patients who received them during surgeries.

Basically, the body sees transfused blood as a foreign substance, causing the immune system to become overwhelmed.

Patients who have received transfusions showed long-term health issues, including higher risk of kidney failure, Carmeci said.

"We learned that it improves longevity to cut back on transfusions," Carmeci said.

The TEG is a specialized testing device that monitors how well a patient's blood is clotting during surgery. Technicians are given the patient's blood as the surgery is occurring. They run the blood through the TEG, which gives them a precise balance of platelets, plasma, red blood cells and other blood products in real time.

If the surgeon has this information during the procedure, it allows him or her to monitor the amount of blood that is introduced into the body.

"We have cut down our blood use by half," Carmeci said.

Studies have shown that by giving patients less blood, doctors can shorten hospital stays and reduce mortality rates in high blood-loss procedures such as open-heart surgery, RRMC said.

In addition, by not giving unnecessary blood transfusions or medicines, the hospital and patient save money, Carmeci said.

Research conducted by RRMC staff showed the TEG has reduced mortality rates 90 days after surgery from 5.4 percent to 3.3 percent. Post-surgery strokes dropped from 3.6 percent to 2.1 percent. And internal bleeding that resulted in another serious operation for the patient dropped from 5.2 percent to 2.1 percent.

Carmeci said the hospital hopes to expand the TEG test to people suffering from brain bleeding and trauma wounds.

Reach Mail Tribune reporter Chris Conrad at 541-776-4471 or cconrad@mailtribune.com.



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