DISCUSSION
Our results are the first reported use of thermal control technology to
reduce blood wastage in conjunction with EVLP utilizing OCS Lung.
Compared to our previous passive refrigeration standard using the
Performance cooler, the thermal control technology with the ProMed
cooler offered superior conditioning and transportation capabilities. In
addition, the ProMed cooler offers an 18-fold longer validated time to
maintain the required 1 to 6 °C blood storage temperature than our
previous cooler. In keeping with this extended period of stable storage
temperature, wastage dropped from 37.5% of pRBC units to 0% when the
ProMed cooler was implemented for OCS lung. While limited, these
findings suggest significant early improvement in blood wastage for lung
recovery.
Previous publications have demonstrated the superiority of thermal
control technology over passive refrigeration for medication and
emergency blood transportation. Clancy et al. found that the
industry-accepted passive refrigeration was ineffective for
temperature-sensitive medication transport and resulted in significant
temperature excursions for trip durations lasting greater than 3
hours.15 Utilizing thermal control technology, Krook
et al. reported only 1.2% of unit wastage during a four-year review of
prehospital blood transfusion within a Canadian helicopter emergency
medical service.11 Blood is a valuable resource that
is often in short supply.16,17 The coronavirus disease
2019 (COVID-19) pandemic has adversely affected blood donation due to
social distancing and resulted in the cancellation of blood drives,
creating an increasing strain on the national blood
supply.18-20 Hospitals should routinely monitor blood
product wastage as a quality indicator, investigate factors contributing
to the wastage, and establish systems to reduce
wastage.21
Blood wastage accounted for 14.2% of the total units issued for lung
recovery by our institution’s blood bank. All these wasted units were
transported with the Performance cooler. Based on organ
transplantation’s essential and emergent nature, these pRBC units were
stored longer than their cooler’s validated storage duration, resulting
in temperature excursions. Our multidisciplinary team of perfusionists
and blood bank personnel have become more familiar over time with the
storage and stewardship processes, demonstrating the success of quality
improvement practices. To date, all unused pRBC units from canceled
recoveries using the ProMed coolers have been successfully returned to
our blood bank within the validated storage timeframe and reallocated
for future use. In addition to avoiding wastage of a valuable resource,
the ability of thermal control technology to maintain a stable
temperature long-term resulted in a five-year cost savings of
approximately $18,000.
Ultimately, thermal control technology with continuous temperature
monitoring improves quality measurement and patient safety. Using the
iLog temperature logger during the recovery phase allows for real-time,
data-driven clinical decision support. Additionally, every data set is
retrospectively reviewed for quality improvement and assurance. Returned
units are quarantined until the temperature data logger can be reviewed
to ensure proper temperature compliance throughout transportation. At
the same time, process improvements for administered units, such as
inadequate conditioning time, can be identified and addressed.
The implementation of thermal control technology had no impact on
operational efficiency. There is no additional storage or freezer
equipment requirement as the TIC gel panels are stored in existing
refrigerators or freezers at our institution’s blood bank. However, the
conditioning process required for TIC gel panels prior to issuance
required a minimal workflow change for the blood bank technologists.
The ProMed cooler is constructed to protect medical materials such as
blood and commercial bio-pharma products, with relatively easy
conditioning of the modular TIC system panels. However, periodic
inspection of the VIP lid and base surfaces is imperative as this
innovative technology is highly effective only if they hold an internal
vacuum. Therefore, the manufacturer recommends the replacement of the
VIP every five years.
These key features, along with other findings of Martin et al., were the
basis of our institution’s selection of the ProMed cooler for use with
both OCS Lung recovery and the Aeromedical Network.22
In the future, a multi-center approach to thermal control technology
should be further explored and investigated in conjunction with other ex
vivo organ perfusion platforms, such as the OCS Heart and Liver, which
recently received approval from the United States Food and Drug
Administration.