Blood Conservation Operations in Pediatric Cardiac Patients: A Paradigm Shift of Blood Use

摘要

Study DesignEquipmentPerfusion TechniqueStatistical AnalysisResultsRed blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations.MethodsWe retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups.ResultsEven though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization.ConclusionsBlood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.CTSNet classification:20, 21Cardiopulmonary bypass (CPB) is associated with defective hemostasis, which results in bleeding and a requirement for allogeneic blood product transfusions in many pediatric patients undergoing cardiac operations. Conservation of blood has become a priority during surgical procedures because of the shortages of donor blood, the risks associated with the use of allogeneic blood products, and the costs of these products. Further, transfusions expose patients to a variety of potential cellular and humoral antigens, pose risks of disease transmission and immunomodulation, and may alone represent proinflammatory stimuli in the perioperative period. Multidisciplinary approaches are required when considering strategies to limit blood transfusions. Strategies to reduce bleeding and transfusion requirements during surgical procedures include recognizing risk factors, developing transfusion protocols, conserving red blood cells (RBCs), using new alternatives to RBCs, altering inflammatory responses, and improving anticoagulation reversal [