Original articleCongenital heart surgeryBlood Conservation Operations in Pediatric Cardiac Patients: A Paradigm Shift of Blood Use
Section snippets
Study Design
Retrospective analysis of 168 pediatric patients who underwent open cardiac operations from 2006 to 2010 was performed to compare the outcomes of blood conservation operations with traditional operations. The first group underwent surgical repair between 2006 and 2008 (historical control) by a different surgeon using conventional CPB without the availability and use of our current blood conservation equipment, techniques, and RBC transfusion protocol. The second group underwent surgical repair
Results
There were statistically no discernible differences in age, sex, weight, and preoperative and postoperative hemoglobin levels between the 2 groups for BV repair (Table 3). The blood conservation group had longer CPB (p < 0.0001) and cross-clamp times (p < 0.002), with lower hemoglobin levels (p < 0.0001) during the surgical procedure. There was less need for intraoperative (p < 0.0001) and postoperative RBC transfusions (p < 0.018), and there were lower inotropic scores (p < 0.0001), shorter
Comment
Blood conservation has been an ongoing quest since pediatric cardiac surgery was in its very infancy. Recent decades have witnessed many improvements in all stages of cardiac operations, allowing for a move toward bloodless surgical procedures in adult patients [6] and even in pediatric patients in some specific fields [7]. Moreover, blood transfusion has been associated with an increased mortality rate [8], and it remains unclear if it improves survival. Low hemoglobin levels during CPB in
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2020, Journal of Thoracic and Cardiovascular SurgeryPediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :However, it is important to note that a separate randomized trial demonstrated that a nadir hematocrit of 20% on CPB resulted in a lower postoperative cardiac index, higher lactate levels, and worsened neurodevelopmental outcomes at 1 year compared with nadir hematocrit of 30%.27 Follow-up studies suggest that a hematocrit of 24% is adequate to preserve both clinical and neurodevelopmental outcomes.26,28-30 However, neonates, patients with cyanotic disease, and other unique populations may require a higher hematocrit.
Blood utilization and conservation
2018, Critical Heart Disease in Infants and ChildrenBlood Conservation
2015, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :95(3):962-7, 2013. Karimi et al8from Georgia Health Science University studied the implementation of a blood conservation strategy in pediatric cardiac patients. In 2008, a restructuring introduced a comprehensive blood conservation program.
Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study
2015, Annals of Thoracic SurgeryCitation Excerpt :These results must be interpreted with caution, however, because no definitive conclusion on a cause-and-effect relationship between RBC transfusion and poor outcomes of cardiac children who have received a transfusion can be drawn from a descriptive study [26]. In recent years, as a result of the accumulation of data suggesting an association between RBC transfusion and increased postoperative morbidity, a greater emphasis has been placed on blood conservation during pediatric cardiac operations [27]. Several strategies have been successfully used to reduce the need for postoperative RBC transfusion.