Perfusion techniques toward bloodless pediatric open heart surgery

Area of Science:

• Pediatric Cardiac Surgery
• Cardiopulmonary Bypass
• Transfusion Medicine

Background:

• Blood transfusions negatively impact adult morbidity and mortality, increasing infection risk and hospital stay.
• Despite efforts in adult centers, blood transfusions remain frequent in pediatric cardiac surgery.
• Jehovah's Witness patients necessitate specialized approaches to minimize blood transfusions.

Purpose of the Study:

• To evaluate the effectiveness of implementing bloodless cardiac surgery techniques in a pediatric setting.
• To assess the feasibility of reducing blood component usage during pediatric cardiopulmonary bypass.
• To compare bloodless surgery rates before and after the adoption of new protocols.

Main Methods:

• Minimized cardiopulmonary bypass circuit size.
• Increased utilization of acute normovolemic hemodilution (ANH), retrograde arterial prime (RAP), and venous antegrade prime (VAP).
• Recorded use of ultrafiltration techniques and cell salvage during and after cardiopulmonary bypass.

Main Results:

• The rate of bloodless open-heart surgeries in pediatric patients increased from 30% (2003-2005) to 43% (2006-2008).
• Bloodless surgery rates more than doubled in pediatric weight groups (0-6, 6-15, 15-20 kg) after 2006.
• ANH use increased from <1% to 42%, and RAP/VAP use increased from <1% to 70% between the periods.

Conclusions:

• Bloodless open-heart surgery is achievable in pediatric cardiac surgical centers, including neonates.
• The adoption of bloodless techniques significantly improved outcomes and reduced transfusion dependency.
• Cooperation among the entire cardiac surgical team is crucial for successful implementation.