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.