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Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis
Ariane Willems1, Karen Harrington, Jacques Lacroix
1Pediatric Intensive Care Unit, Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.
Insights
A restrictive red-cell transfusion strategy did not significantly differ from a liberal approach in preventing multiple organ dysfunction syndrome in pediatric cardiac surgery patients. This finding suggests current transfusion thresholds may be too high for this population.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Transfusion medicine
Background:
- The optimal red-cell transfusion threshold for pediatric patients undergoing cardiac surgery remains unclear.
- Multiple organ dysfunction syndrome (MODS) is a significant complication in this patient population.
Purpose of the Study:
- To compare the impact of restrictive versus liberal red-cell transfusion strategies on new or progressive MODS in children after cardiac surgery.
Main Methods:
- A randomized controlled trial was conducted within pediatric intensive care units.
- Participants were a subgroup of pediatric cardiac surgery patients from the TRIPICU study.
- Patients with hemoglobin < or = 95 g/L were randomized to restrictive (<70 g/L) or liberal (95 g/L) transfusion thresholds.
Main Results:
- No significant difference in new or progressive MODS was observed between the restrictive (12.7%) and liberal (6.5%) groups (p = .36).
- Length of pediatric intensive care unit stay and 28-day mortality were also similar between groups.
- Mean hemoglobin levels were consistently lower in the restrictive group post-randomization.
Conclusions:
- In pediatric cardiac surgery patients, a restrictive red-cell transfusion strategy did not lead to a significant increase in MODS compared to a liberal strategy.
- The study suggests that current transfusion thresholds may not be optimal for this specific patient group, but further definitive evidence is needed.
Objective:
To determine the impact of a restrictive vs. a liberal transfusion strategy on new or progressive multiple organ dysfunction syndrome in children post cardiac surgery. The optimal transfusion threshold after cardiac surgery in children is unknown.
Design:
Randomized, controlled trial.
Setting:
Tertiary pediatric intensive care units.
Patients:
Participants are a subgroup of pediatric patients post cardiac surgery from the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study. Exclusion criteria specific to the cardiac surgery subgroup included: age <28 days and patients remaining cyanotic.
Intervention:
Critically ill children with a hemoglobin < or = 95 g/L within 7 days of pediatric intensive care unit admission were randomized to receive prestorage leukocyte-reduced red-cell transfusion if their hemoglobin dropped either <70 g/L (restrictive) or 95 g/L (liberal).
Measurements And Main Results:
Postoperative cardiac patients (n = 125) from seven centers were enrolled. The restrictive (n = 63) and liberal (n = 62) groups were similar at baseline in age (mean +/- standard deviation = 31.4 +/- 38.1 mos vs. 26.4 +/- 39.1 mos), surgical procedure, severity of illness (Pediatric Risk of Mortality score = 3.4 +/- 3.2 vs. 3.2 +/- 3.2), multiple organ dysfunction syndrome (46% vs. 44%), mechanical ventilation (62% vs. 60%), and hemoglobin (83 vs. 80 g/L). Mean hemoglobin remained 21 g/L lower in the restrictive group after randomization. No significant difference was found in new or progressive multiple organ dysfunction syndrome (primary outcome) in the restrictive group vs. liberal group (12.7% vs. 6.5%; p = .36), pediatric intensive care unit length of stay (7.0 +/- 5.0 days vs. 7.4 +/- 6.4 days) or 28-day mortality (3.2% vs. 3.2%).
Conclusion:
In this subgroup analysis of cardiac surgery patients, a restrictive red-cell transfusion strategy, as compared with a liberal one, was not associated with any significant difference in new or progressive multiple organ dysfunction syndrome, but this evidence is not definitive.
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