A new approach to massive blood transfusion during pediatric liver resection

Area of Science:

• Pediatric Surgery
• Transfusion Medicine
• Oncology

Background:

• Hemorrhage and massive transfusion complications pose significant risks during pediatric liver resection.
• Tumor resections in children often necessitate large blood volumes and rapid transfusion capabilities.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel rapid blood transfusion method in pediatric patients undergoing extensive hepatic resection.
• To assess physiological stability during massive blood transfusions in young children.

Main Methods:

• A rapid infusion device utilizing a roller pump and oxygenator-warmer circuit was employed.
• Washed packed red blood cells were resuspended in fresh-frozen plasma and Plasmalyte, then warmed, oxygenated, and buffered.
• Four pediatric patients (8-35 months) undergoing hepatic resection for tumors received an average of 5130 ml of reconstituted blood per patient.

Main Results:

• Average infusion rates were 122 +/- 45 ml/min, with peak rates reaching 1 L/min.
• Key physiological parameters including cardiac output, pulmonary artery wedge pressure, body temperature, urine output, blood gases, blood chemistries, and coagulation factors remained stable.
• No significant adverse events related to the rapid transfusion method were observed.

Conclusions:

• Rapid blood transfusion during pediatric liver resection is feasible and safe when the storage lesion of bank blood is corrected.
• This technique effectively addresses the challenges of massive transfusion in pediatric oncology surgery.
• Maintaining physiological homeostasis is achievable even with high-volume, rapid blood administration.