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A structured blood conservation program in pediatric cardiac surgery
A B Budak1, K McCusker, S Gunaydin
1Department of Cardiovascular Surgery, New York Medical College, NY, USA. drbaranbudak@gmail.com.
Insights
Implementing a blood conservation program significantly reduced red blood cell transfusions and improved outcomes in infants undergoing pediatric cardiac surgery. This approach offers benefits beyond just reducing transfusion risks.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Patient Blood Management
Background:
- Limited alternatives for infant transfusions necessitate effective blood conservation.
- Blood conservation programs aim to minimize transfusions and associated complications.
Purpose of the Study:
- To analyze the efficacy of a structured blood conservation program in reducing transfusions and complications.
- To compare outcomes in infants undergoing biventricular repair with and without a blood conservation program.
Main Methods:
- Retrospective review of a pediatric surgery database comparing two 12-month periods.
- Analysis of 214 infants (blood conservation group) vs. 250 infants (control group) undergoing biventricular repair with cardiopulmonary bypass (CPB).
Main Results:
- Red blood cell transfusion rates decreased from 75.2% to 58.8% (p < 0.01).
- Mean transfusions per patient reduced from 1.25 to 0.7 (p = 0.035).
- Improved cerebral oximetry, reduced respiratory support, inotropic need, and ICU stay were observed.
Conclusions:
- Blood conservation is justified in pediatric cardiac surgery due to transfusion risks, costs, and improved outcomes.
- Factors like circuit miniaturization, ultrafiltration, and reduced bleeding contributed to the positive results.
Objective:
The limitation of alternative transfusion practices in infants increases the benefits of blood conservation. We analyzed the efficacy of a structured program to reduce transfusions and transfusion-associated complications in cardiac surgery PATIENTS AND METHODS: Our pediatric surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of an effective blood conservation program beginning in March 2014. A total of 214 infants (8.1±3.4 months) who underwent biventricular repair utilizing CPB (Group 1 - Blood conservation) were studied in a 12-month period (March 2014-February 2015) after the implementation of the new program, and compared with 250 infants (7.91±3.2 months) (Group 2 - Control-No blood conservation) of the previous 12-month period (March 2013-February 2014).
Results:
The proportion of patients transfused with red blood cells was 75.2% (N=188) in control group and reduced by 16.4% in the study group (58.8% - 126 patients, p <0.01). The mean number of transfusions was 1.25 ± 0.5 units per patient in control group and decreased to 0.7 ± 0.5 units per patient after the start of the program (p = 0.035). Cerebral oximetry demonstrated better follow-up during the operative period confirming less hemodilution in Group 1. Respiratory support, inotropic need and ICU stay were significantly better in the study group.
Conclusions:
These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations. Circuit miniaturization, ultrafiltration, and reduced postoperative bleeding, presumably secondary to higher fibrinogen and other coagulation factor levels, contributed to this outcome.
