Patient Blood Management for Neonates and Children Undergoing Cardiac Surgery: 2019 NATA Guidelines

Area of Science:

• Cardiovascular Surgery
• Hematology
• Pediatric Critical Care

Background:

• Pediatric cardiac surgery carries a high risk of bleeding, often necessitating allogeneic blood transfusions.
• Existing patient blood management (PBM) guidelines primarily focus on adults, with limited specific evidence for pediatric cardiac surgery.
• A gap exists in dedicated guidelines for implementing PBM in neonates and children undergoing cardiac procedures.

Purpose of the Study:

• To develop evidence-based recommendations for anemia management and blood transfusion practices in pediatric cardiac surgery.
• To address the lack of specific guidelines for PBM in this vulnerable patient population.
• To identify research gaps in pediatric cardiac PBM.

Main Methods:

• A task force from the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) was convened.
• The task force aimed to synthesize existing evidence and provide expert recommendations.
• Focus on perioperative care of neonates and children undergoing cardiac surgery.

Main Results:

• Current evidence for PBM implementation in pediatric cardiac surgery is mainly from systematic reviews.
• Specific, comprehensive guidelines for this population are currently unavailable.
• The need for optimized hemoglobin, reduced blood sampling, improved hemostasis, and blood-sparing techniques is highlighted.

Conclusions:

• Evidence-based recommendations are needed to guide PBM in pediatric cardiac surgery.
• Implementing PBM strategies can potentially reduce allogeneic blood product administration.
• Further research is essential to refine PBM protocols for neonates and children undergoing cardiac surgery.