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Effect of Red Blood Cell Storage Duration on Outcome After Paediatric Cardiac Surgery: A Prospective Observational
Arvind Kumar Bishnoi1, Pankaj Garg1, Kartik Patel1
1Department of Cardiovascular and Thoracic Surgery UN Mehta Institute of Cardiology and Research Center and BJ Medical College, New Civil Hospital, Asarwa, India.
Insights
Using stored red blood cells for pediatric cardiac surgery bypass priming is safe, regardless of storage duration. Metabolic profiles normalize during bypass, with no significant increase in complications or mortality even with older blood products.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Transfusion Medicine
Background:
- Retrospective studies suggest stored red blood cells increase postoperative complications.
- The impact of red blood cell storage duration on pediatric cardiac surgery outcomes requires prospective evaluation.
Purpose of the Study:
- To prospectively assess the effect of packed red blood cell (PRBC) storage duration on metabolic profiles.
- To evaluate the influence of PRBC storage duration on postoperative outcomes in pediatric cardiac surgery patients.
Main Methods:
- 198 pediatric patients undergoing cardiopulmonary bypass (CPB) were enrolled.
- Patients were grouped by PRBC storage duration: ≤14 days (newer) vs. >14 days (older).
- Metabolic profiles and postoperative outcomes were compared between groups.
Main Results:
- Metabolic parameters normalized post-CPB initiation in both newer and older PRBC groups.
- While complications were numerically higher in the older PRBC group, differences were not statistically significant.
- No significant differences were observed in ventilation duration, ICU/hospital stay, or mortality.
Conclusions:
- Stored PRBC metabolic parameters normalize during CPB, irrespective of storage duration.
- Washed stored red blood cells up to 28 days are safe for CPB priming in pediatric cardiac surgery.
- This is particularly true when minimal transfusion is required and in patients without significant comorbidities.
Background:
Retrospective reviews have found the use of stored packed red blood cells (PRBCs) in priming to be associated with increased risk of postoperative complications. The purpose of study was to prospectively investigate the influence of duration of storage of PRBCs used in priming the cardiopulmonary bypass (CPB) circuit on the metabolic profile of the patients, and postoperative outcome after paediatric cardiac surgery.
Methods:
Between January 2015 and December 2015, 198 consecutive children operated for cardiac surgery using CPB and received blood for priming the circuit were included. Patients were divided into two groups based on the duration of storage of the blood, newer PRBCs group who received blood stored for ≤14days and the older PRBCs group who received blood stored for >14 days.
Results:
Mean duration of blood storage used for priming in newer PRBCs blood group (n=103) was 8.4±3.7days while it was 21.9±4.5days in older PRBCs group (n=95). Metabolic parameters of the PRBCs improved to physiological limits in both the groups after initiation of CPB. Postoperative hepatic, pulmonary, haematological complications, sepsis and multi-organ failure were more in the old PRBCs group. However, the difference was not significant. Similarly, there was no significant difference in incidence of prolonged mechanical ventilation, intensive care unit stay and hospital stay and mortality between the two groups.
Conclusions:
Metabolic parameters of the stored blood become normal after initiation of CPB irrespective of duration of storage. In paediatric patients without significant co-morbidity, undergoing cardiac surgery, transfusion of washed stored blood up to 28days in CPB priming is safe especially if lesser amount of transfusion is required.
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