Related Experiment Video
Updated: Aug 25, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery
Yoshio Ootaki1, Masahiro Yamaguchi, Naoki Yoshimura
1Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan. y.ootaki@nifty.ne.jp
Insights
A criterion-driven transfusion protocol using low-hematocrit bypass in pediatric cardiac surgery is effective. This approach, with a hematocrit below 20%, may influence lactate levels during recovery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Transfusion Medicine
Background:
- Low-hematocrit bypass is a strategy to minimize allogeneic transfusions during cardiopulmonary bypass.
- Managing blood transfusions in pediatric cardiac surgery is critical for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a criterion-driven transfusion protocol.
- To assess the impact of low-hematocrit bypass with moderate hypothermia in pediatric cardiac surgery.
Main Methods:
- Seventy-five pediatric patients undergoing cardiopulmonary bypass for congenital heart disease repair were studied.
- Transfusion criteria included hematocrit <15% during bypass and <20% post-bypass.
- Continuous monitoring of venous oxygen saturation, hematocrit, and regional cerebral oxygenation; postoperative arterial lactate levels were measured.
Main Results:
- No perioperative deaths occurred; 29.3% of patients received transfusions.
- Nontransfused patients had lower pre- and post-modified ultrafiltration hematocrit levels (P <.05).
- Arterial lactate levels at 6 hours post-ICU admission were higher in nontransfused patients (P <.05); patient weight correlated with lactate levels (R = 0.678, P <.0001).
Conclusions:
- A criterion-driven transfusion program is effective in pediatric cardiac surgery.
- Low-hematocrit bypass (hematocrit <20%) may influence lactate production or clearance.
- This protocol can help avoid allogeneic transfusions while maintaining patient safety.
Objectives:
Low-hematocrit bypass is one technique used to prevent allogeneic transfusion during cardiopulmonary bypass. The purpose of this study is to determine the efficacy of a criterion-driven transfusion protocol and the effect of low-hematocrit bypass with moderate hypothermia in pediatric cardiac surgery.
Methods:
Seventy-five children who underwent cardiopulmonary bypass with low-hematocrit bypass for repair of congenital heart disease were studied. Criteria for red blood cell transfusion included anemia with a hematocrit level of less than 15% during bypass and 20% after bypass. During cardiopulmonary bypass, venous oxygen saturation, hematocrit values, and regional cerebral oxygenation were continuously monitored. Arterial lactate levels were measured postoperatively.
Results:
All patients had an uncomplicated perioperative course, and no perioperative death occurred. Twenty-two patients (29.3%) received a transfusion, and 53 (70.7%) patients did not. The hematocrit levels before and after modified ultrafiltration in the transfused group (21.6 +/- 5.5%, 26.6 +/- 6.5%) were significantly higher than those in the nontransfused group (18.9 +/- 3.7%, 23.1 +/- 4.1%) (P <.05). There was no significant difference between the group's arterial lactate levels immediately after admission to the intensive care unit and 1 day after the operation. The arterial lactate levels 6 hours after the admission to the intensive care unit for the nontransfused patients were higher than with the transfused patients (4.3 +/- 3.0 versus 2.5 +/- 1.5 mmol/L, (P <.05). For arterial lactate level, the relation with patients' weight had the highest correlation (R = 0.678, P <.0001).
Conclusions:
A criterion-driven transfusion program can be effective, and low-hematocrit bypass with a hematocrit value below 20% may affect lactate production or clearance from the body.
