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Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative
Alaina K Kipps1, David Wypij, Ravi R Thiagarajan
1Pediatric Division of Cardiology, UCSF Children's Hospital, and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Insights
Greater intraoperative and early postoperative blood transfusions in infants undergoing heart surgery may prolong mechanical ventilation duration. Reducing blood product use could potentially speed up recovery after infant cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Hematology
- Critical Care Medicine
Background:
- Perioperative transfusion is linked to adverse outcomes in adult cardiac surgery.
- Infant heart surgery involves complex procedures with potential for significant blood loss and transfusion needs.
Purpose of the Study:
- To investigate if increased blood and blood product use predicts prolonged postoperative recovery in infants undergoing corrective heart surgery.
- To identify predictors of duration of mechanical ventilation (DMV) after infant cardiac repair.
Main Methods:
- Secondary analysis of prospectively collected data from two randomized trials.
- Included 270 infants undergoing two-ventricle corrective cardiac surgery without aortic arch reconstruction.
- Examined association between perioperative transfusion and DMV.
Main Results:
- Higher intraoperative and early postoperative blood product transfusion correlated with longer DMV (p < .001).
- Increased intraoperative blood products per kg was associated with a 49% lower risk of being extubated (HR, 0.51).
- Transfusion on postoperative day 1 reduced extubation risk (HR, 0.65).
Conclusions:
- Greater intraoperative and early postoperative blood transfusion are potential risk factors for prolonged mechanical ventilation in infants.
- Further prospective trials are needed to confirm if reducing blood product administration improves recovery post-infant heart surgery.
Objective:
Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery.
Design:
Secondary analysis of prospectively collected data from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart surgery to explore the association of DMV with perioperative transfusion and other variables.
Setting:
Tertiary pediatric hospital.
Patients:
Two hundred seventy infants undergoing two ventricle corrective cardiac surgery without aortic arch reconstruction.
Measurements And Main Results:
In univariable analyses, longer DMV was associated with younger age and lower weight at surgery, diagnostic group, and higher intraoperative and postoperative blood product transfusion (each p < .001). In multivariable proportional hazard regression, longer total support time and greater intraoperative and early postoperative blood products per kg were the strongest predictors of longer DMV. Patients in the highest tertile of intraoperative blood products per kg had an instantaneous risk of being extubated approximately half that of patients in the lowest tertile (hazard ratio, 0.51; 95% confidence interval, 0.35, 0.73). Patients who received any blood products on postoperative day 1, compared with those who did not, had a hazard ratio for extubation of 0.65 (95% confidence interval, 0.50, 0.85).
Conclusions:
In this exploratory secondary analysis of infants undergoing two ventricular repair of congenital heart disease without aortic arch obstruction, greater intraoperative and early postoperative blood transfusion emerged as potential important risk factors for longer DMV. Future prospective clinical trials are needed to determine whether reduction in blood product administration hastens postoperative recovery after infant heart surgery.
