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

Authors: Longrois, D; Albaladejo, P; Bedague, D; Ouattara, A; Bouglé, A; Dureau, P; Cholley, B; Mertes, P-M; Provenchère, S; Robin, E; Besch, G; Grelet, T; Grosjean, S; Guinot, P-G; Rozec, B; Rigal, J-C; Fellahi, J-L; Colson, P

Affiliations : Departement of Anaesthesia and Intensive Care, DMU (Département Médico-Universitaire) PARABOL, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, INSERM 1140, Paris, France. Department of Anesthesiology and Critical Care, TIMC-Themas-(UMR CNRS 5525), Grenoble Alpes University Hospital, Grenoble, France. Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, 33000, Bordeaux, France. Univ. Bordeaux, INSERM, BMC, U1034, F-33600, Pessac, France. Department of Anesthesiology and Critical Care Medicine, Sorbonne University, Cardiology Institute, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. Department of Anaesthesia, Intensive Care & Perioperative Medicine, Université Paris Cité, INSERM UMR-S1140, 75006APHP Paris. Hôpital Européen Georges Pompidou, Paris, France. Pôle Anesthésie Réanimation Et Médecine Périopératoire, Nouvel Hôpital Civil, UMR INSERM U1255 – FMTS, Strasbourg, France.

Publication: BMC anesthesiology ; 2025 ; 25. 594

ABSTRACT: 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 multicenter 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 centers 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 centers 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 centers 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).