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Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study
Amine Mazine1, Soha Rached-D'Astous2, Thierry Ducruet3
1Department of Cardiac Surgery, Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
Insights
Pediatric cardiac surgery patients frequently receive red blood cell transfusions, often without clear hemoglobin thresholds. This variability highlights the need for standardized transfusion guidelines in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Hematology
Background:
- Red blood cell transfusion is a critical supportive therapy post-pediatric cardiac surgery.
- Current guidelines lack specific hemoglobin thresholds for transfusions in this population.
- Anemia is common in critically ill children, necessitating characterization of transfusion practices.
Purpose of the Study:
- To characterize anemia development and red blood cell transfusion patterns in pediatric intensive care unit (PICU) patients after cardiac operations.
- To identify factors influencing transfusion decisions and outcomes in this cohort.
- To assess variability in transfusion practices across different PICUs.
Main Methods:
- Prospective, multicenter observational cohort study involving 30 North American PICUs.
- Enrolled 977 critically ill children (aged <18 years) requiring ≥48 hours in the PICU.
- Analyzed a subgroup of 175 postcardiac surgical patients.
Main Results:
- 54% of pediatric cardiac surgery patients developed anemia during their PICU stay.
- 79% received at least one red blood cell transfusion, with longer PICU stays observed in transfused patients.
- Low hemoglobin was the primary indication for transfusion in only 17% of cases, indicating practice variability.
Conclusions:
- Pediatric cardiac surgical patients exhibit a high incidence of red blood cell transfusions.
- Significant variability in transfusion practices exists across North American PICUs.
- There is a critical need for evidence-based transfusion guidelines for this vulnerable patient group.
Background:
Red blood cell transfusion is an important supportive measure after pediatric cardiac operations. However, no clear hemoglobin threshold has been established. This study characterized anemia development and red blood cell transfusions in the pediatric intensive care unit (PICU) after cardiac operations.
Methods:
A prospective, multicenter, 6-month cohort study on the management of anemia in critically ill pediatric patients was conducted in 30 North American PICUs. This observational study enrolled 977 consecutive children (aged <18 years) who stayed in the PICU for 48 hours or more. We analyzed a subgroup of postcardiac surgical patients from this study.
Results:
Included were 175 cardiac patients, 56% of whom had cyanotic heart disease. The mean Pediatric Risk of Mortality (PRISM III) score was 6.4 ± 5.4. Fifty-four percent of children were anemic in the PICU (20% on admission, 34% during PICU stay). Most patients (79%) received at least one red blood cell transfusion in the PICU. Patients who received a transfusion had a significantly longer PICU stay (9.3 ± 6.3 vs 6.1 ± 5.4 days, p = 0.01). Pretransfusion hemoglobin was different in acyanotic and cyanotic patients (mean ± standard deviation: 11.1 ± 2.2 g/dL and 11.8 ± 2.1 g/dL, respectively). According to the attending physician, a low hemoglobin level was the primary indication for transfusion in only 17% of cases.
Conclusions:
Pediatric cardiac surgical patients are at high risk of receiving red blood cell transfusions. This study, which showed great variability in transfusion practices across North American PICUs, highlights the need for clearer transfusion guidelines in this specific population.
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