The impact of rapid infusers on the hemostatic potential of cryoprecipitate products

BACKGROUND: In cases of massive transfusion, intravenous access can be limited. Additionally, delivering different products through separate lines and infusion methods adds unnecessary steps. RBC, plasma, and whole blood (WB) are delivered via rapid infusers; cryoprecipitate (CRYO) is infused through separate access and is not approved with these devices. STUDY DESIGN AND METHODS: We examined the impact of different transfusion methods on hemostatic performance and factor activity using two available CRYO products. Ten bags of CRYO, ten bags pathogen-reduced CRYO (Intercept® Fibrinogen Complex, IFC), and 20 units of WB were obtained. Each CRYO bag was infused with one unit of WB by three techniques: (1) gravity infusion with filter, (2) rapid infuser at 70 mL/min, and (3) pressure bag and filter. Hemostatic potential was measured by thrombelastography (TEG), thrombin generation (CAT), and factor levels (ACLTOP). Post-each infusion, disposable tubing and infusion parts were inspected for evidence of clumping or clogging. RESULTS: Both standard CRYO and IFC demonstrated maintained or improved TEG, CAT, and factor levels when subjected to a rapid infuser device and pressure bag. When compared with gravity infusion, a rapid infuser device and pressure bag demonstrated maintained or improved values by TEG, CAT, and factor activity. No evidence of clumping or clogging of tubing was encountered in the 20 runs performed. No evidence of system dysfunction with use of CRYO through these devices was found either. DISCUSSION: Restriction of CRYO infusion through rapid infuser devices or with pressure bags should be reconsidered. Future clinical trials are warranted.