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Bloodless cardiac surgery and the pediatric patient: a case study
A L Ging1, J R St Onge, D C Fitzgerald
1INOVA Fairfax Hospital, Perfusion Department, Falls Church, VA 22042, USA.
Perfusion
|October 9, 2008
Summary
Pediatric cardiac surgery can avoid homologous blood transfusions using a combination of strategies. This approach minimizes risks associated with both transfusions and excessive hemodilution, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Transfusion Medicine
Background:
- Peri-operative blood transfusions in cardiac surgery correlate with increased morbidity and mortality.
- Avoiding homologous blood products can lead to detrimental hemodilution, impacting oxygen delivery and causing coagulopathy, especially in pediatric patients.
- The large discrepancy between pediatric patient blood volume and cardiopulmonary bypass (CPB) circuit priming volume presents unique challenges.
Observation:
- A 5.9 kg infant underwent successful ventricular septal defect repair without homologous blood transfusion.
- The surgical team employed a multi-faceted strategy to manage blood volume and minimize transfusion needs.
Findings:
- Key strategies included pre-operative erythropoietin and iron, acute normovolemic hemodilution (ANH), retrograde autologous priming (RAP), cell salvage, continuous ultrafiltration, and vacuum-assisted venous drainage.
- Near-infrared spectroscopy (NIRS) was used for intraoperative monitoring.
- Miniaturization of the CPB circuit and bypass techniques were crucial for avoiding excessive hemodilution.
Implications:
- This comprehensive strategy is now standard practice for the institution's pediatric cardiac surgical population.
- Successful implementation demonstrates a viable alternative to homologous blood transfusions in complex pediatric cardiac procedures.
- The findings support the integration of advanced bypass techniques and blood management strategies to enhance safety in pediatric cardiac surgery.
