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Effect of Prime Blood Storage Duration on Clinical Outcome After Pediatric Cardiac Surgery
Arvind Kumar Bishnoi1, Pankaj Garg1, Kartik Patel1
11 Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Insights
The storage duration of packed red blood cells (PRBCs) used in pediatric cardiopulmonary bypass (CPB) did not significantly impact patient complications or metabolic profiles post-surgery. Longer storage times for PRBCs did not correlate with increased morbidity or mortality.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Transfusion Medicine
Background:
- Pediatric cardiac surgery frequently utilizes cardiopulmonary bypass (CPB) with packed red blood cells (PRBCs) for priming.
- The impact of PRBC storage duration on patient outcomes in this setting remains a critical area of investigation.
Purpose of the Study:
- To investigate the association between the storage duration of PRBCs used in CPB prime and postoperative complications in pediatric patients.
- To evaluate the effect of PRBC storage duration on the metabolic profiles of pediatric patients during and after CPB.
Main Methods:
- A prospective observational study included 400 pediatric patients undergoing cardiac surgery with CPB requiring PRBC prime.
- Patients were stratified into four groups based on PRBC storage duration: ≤7 days, 8-14 days, 15-21 days, and >21 days.
Main Results:
- Univariate analysis suggested higher postoperative complications with PRBCs stored >14 days (e.g., liver dysfunction, sepsis).
- However, regression analysis revealed no significant association between PRBC storage duration and postoperative complications or mortality after adjusting for confounders.
- While PRBC metabolic profiles showed derangement with longer storage, these normalized early after CPB initiation and remained stable post-surgery.
Conclusions:
- The storage duration of PRBCs for pediatric CPB prime does not influence patient metabolic profiles during or immediately after surgery.
- PRBC storage duration is not associated with increased postoperative complications or mortality in pediatric cardiac surgery patients.
Background:
In this study, we tested the hypothesis that in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) with blood prime, the storage duration of the packed red blood cells (PRBCs) used in prime led to differences in postoperative complications and metabolic profiles of the patients.
Methods:
For this prospective observational study we included 400 pediatric patients undergoing cardiac operations using CPB and requiring PRBCs prime. To study the effect of storage duration of PRBCs on postoperative morbidity, mortality, and metabolic profile, patients were divided into four groups (based on storage duration of PRBCs used in prime). Group 1: ≤7 days, group 2: 8 to 14 days, group 3: 15 to 21 days, and group 4: >21 days.
Results:
On univariate analysis, patients transfused with PRBCs stored >14 days had significantly higher incidence of postoperative complications, for example, liver dysfunction, hematological complications, sepsis, and multiorgan failure. However, after regression analysis and adjusting for the other confounder's effects, no significant association was found between storage duration of PRBCs and postoperative complications and mortality. Metabolic profile of PRBCs was observed to become deranged with increasing duration of storage. This, however, improved to near physiological range early after the initiation of CPB and remained normal one hour after weaning from CPB, irrespective of the storage duration.
Conclusion:
Storage duration of PRBCs used for priming the pediatric CPB circuit neither affects the metabolic profile of the patients on CPB or early after surgery, nor it has any association with postoperative complications and mortality.
