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Multiple Approaches to Minimize Transfusions for Pediatric Patients in Open-Heart Surgery
Jae Gun Kwak1, MinKyoung Park2, JinKwon Lee2
1Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-Si, Gyeonggi-Do, Republic of Korea. switch.surgeon@gmail.com.
Insights
Reducing blood transfusions in pediatric open-heart surgery patients using a targeted strategy significantly shortened intensive care unit stays and reduced complications. This approach minimized blood product use without adverse effects, improving patient recovery outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Critical Care
Background:
- Blood transfusions in pediatric open-heart surgery can lead to complications.
- Minimizing allogeneic blood exposure is crucial for patient safety and outcomes.
Purpose of the Study:
- To evaluate a strategy for reducing perioperative blood product use in pediatric patients undergoing open-heart surgery.
- To assess the impact of reduced transfusion volume on postoperative outcomes.
Main Methods:
- Retrospective review of 349 pediatric patients (<15 years, ≤30 kg) undergoing open-heart surgery.
- Strategy included: optimized cardiopulmonary bypass (CPB) priming, routine modified ultrafiltration, and restrictive postoperative red blood cell (RBC) transfusion criteria (hematocrit ≤25%).
Main Results:
- 23.2% of patients did not require blood products; 34.1% did not receive RBCs in CPB priming.
- Patients not requiring transfusion had significantly shorter intensive care unit (ICU) stays (0.97 ± 0.5 days vs. 4.1 ± 5.5 days).
- Reduced transfusion volume correlated with shorter ventilator support, ICU/hospital stays, and decreased inflammatory and kidney injury markers.
Conclusions:
- The implemented strategy effectively reduced blood transfusion volumes in pediatric open-heart surgery.
- This approach led to improved postoperative outcomes, including shorter ICU stays and reduced complications.
- Lower hematocrit levels within the study parameters did not result in observed adverse events.
Abstract:
We have attempted to reduce blood use during the perioperative period to avoid complications associated with blood transfusions in pediatric patients undergoing open-heart surgery. We retrospectively reviewed clinical data of patients who underwent open-heart surgery (age < 15 years, body weight ≤ 30 kg) from January 2012 to October 2013. Our strategy to reduce transfusion volume included: (1) shortening the length of cardiopulmonary bypass (CPB) circuit, and adding red blood cells (RBC) to CPB circuit priming solution when preoperative hematocrit was ≤30%; (2) routine modified ultrafiltration in all patients; and (3) restricting RBC transfusions during postoperative period, given when hematocrit was ≤25%. In total, 349 cases were enrolled. The median age of patients was 7 months (1 day-168 months), and body weight was 7 kg (2.3-30 kg). We did not use blood products in 81 (23.2%) cases and did not add RBCs to CPB priming solution in 119 (34.1%) cases. Patients who did not require a transfusion showed a shorter intensive care unit (ICU) stays (0.97 ± 0.5 days) than patients who required a transfusion (4.1 ± 5.5 days, p = 0.003). Larger volume transfusion correlated with longer intubation durations, ICU and hospital stays, higher peak C-reactive protein levels, and an increased blood urea nitrogen/creatinine ratio. No significant problems were observed in patients with relatively lower hematocrit levels. Our strategy to reduce transfusion volume resulted in shorter ventilator support, ICU stay, hospitalization, reduced inflammatory reaction, and less kidney insult during the postoperative course in pediatric patients.
