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VCSQI RBC Protocol

VCSQI RBC Protocol

The "VCSQI RBC Protocol" is a comprehensive guideline developed by the Virginia Cardiac Services Quality Initiative (VCSQI), aimed at optimizing red blood cell transfusion practices in cardiac surgery across 17 hospitals and 13 surgical practices in Virginia. This multi-center protocol is focused on reducing unnecessary blood transfusions, which are common in cardiac surgery and associated with increased morbidity, prolonged hospital and ICU stays, and even elevated mortality rates post-surgery.


Key components of the protocol include:

  • Transfusion Triggers: Establishing clear, evidence-based criteria for when transfusions should occur, such as hemoglobin levels below 6.0 or hematocrit below 18, along with signs of tissue hypoperfusion like low SVO2, elevated lactate, or low bicarbonate levels.
  • Postoperative Care: Guidelines for postoperative transfusions in ICU and step-down units, recommending transfusions for hemoglobin levels below 7.0 or hematocrit below 21, with additional criteria such as elevated oxygen needs, hypotension, end-organ dysfunction, or ongoing bleeding.
  • Blood Conservation: A detailed 9-12 point program aimed at conserving a patient's own blood and reducing reliance on transfusions, with a significant drop in transfusion rates from 70% to 12-22% of patients after program implementation.


The protocol also highlights the differential impact of transfusions on male and female patients, noting that women often experience worse outcomes, potentially due to lower baseline blood volumes.


This document serves as a vital resource for healthcare providers in cardiac surgery settings, offering a structured approach to blood transfusion that balances patient safety with resource efficiency. By adopting these guidelines, medical professionals can improve patient outcomes while addressing the substantial costs associated with unnecessary blood transfusions.

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