Dr. Keyvan Karkouti, Dr. Stuart McCluskey and Cielo Bingley
(L to R) Dr. Keyvan Karkouti, Dr. Stuart McCluskey and Cielo Bingley, a Perioperative Blood Conservation Co-ordinator, work together to find ways to ensure that with a limited blood supply, opportunities are found to conserve wherever possible. (Photo: The Globe and Mail)

Dr. Vivek Rao could only talk briefly. The Division Head of Cardiovascular Surgery, and the Peter Munk Cardiac Centre Chair in Advanced Cardiac Therapeutics, had just completed a heart transplant, but the 52-year-old patient was bleeding, and Dr. Rao had to return to him.

Beyond the complexity of operating on the body's life-giving organ, cardiac surgery poses the danger of difficult-to-manage or persistent bleeding.

In the case of Dr. Rao's patient, a novel technique that addresses blood transfusions was successfully used. Employing what's called a point-of-care algorithm, Dr. Rao and his team determined that the man's platelets – the cells needed to help blood clot – were dysfunctional and so they were replaced.

"The point-of-care testing enabled the team to administer only the required platelets and not a wide range of blood products that would ultimately be unnecessary," Dr. Rao says. As well, Dr. Rao discovered a source of bleeding, which was also controlled.

"The patient did well subsequently," he says.

Point-of-care tests are designed to be used at or near the spot where the patient is located, don't require permanent and dedicated space and are performed outside of clinical laboratories. An algorithm is a set of rules to be applied to calculations or problem solving.

At the Peter Munk Cardiac Centre (PMCC), the algorithm addresses blood loss after surgery and allows faster results for targeted therapy, says Dr. Keyvan Karkouti, Site Chief of Anesthesiology at Toronto General Hospital.

"The algorithm allows us, early at the bedside, to identify why patients are bleeding, and once that's identified, to find therapies to target abnormalities we identified," says Dr. Karkouti, who is keenly aware of the algorithm's value.

Between October 2014 and May 2015, a randomized controlled trial of the point-of-care–based transfusion algorithm was tested at 12 Canadian hospitals. None of the sites previously used point-of-care testing for bleeding management during cardiac surgery.

During the seven months, the algorithm was used for 7,402 patients having coronary bypass surgery. Overall, the point-of-care algorithm reduced red blood cell transfusions, platelet transfusions and major bleeding following cardiac surgery.

For Dr. Michael Farkouh, the "out-of-box" thinking that led to this valuable algorithm is truly innovation in action.

"It's a novel, very cost-effective way of improving outcomes," says the Chair of the Peter Munk Centre of Excellence in Multinational Clinical Trials.

With a limited blood supply and a push to conserve such resources throughout the health-care system, Dr. Farkouh, a cardiologist, foresees broad appeal for the algorithm.

"We have the ability to tailor transfusions in patients," he says.

PMCC Magazine 

The third annual Peter Munk Cardiac Centre (PMCC) magazine published by The Globe and Mail focuses on why Canada's premier cardiac centre is known for being "the heartbeat of innovation." The magazine explores the PMCC model that supports the creation, development and evolution of innovative ideas into action – making "today's idea, tomorrow's practice." It also examines the impact that a culture of innovation has on the way cardiovascular care is delivered now and into the future.

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