Pediatric Blood Management Protocol in Cranial Vault Surgery

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Hematology

Background:

• Cranial vault surgeries are extensive procedures often necessitating blood transfusions.
• Previous strategies have aimed to reduce the transfusion burden in these patients.
• The need for effective blood management in pediatric surgical oncology is critical.

Purpose of the Study:

• To evaluate the efficacy of a Pediatric Blood Management (PBM) team in reducing transfusion requirements.
• To assess the impact of a multimodal hematologic management approach on pediatric patients undergoing cranial vault surgery.

Main Methods:

• A protocol was implemented including preoperative hemoglobin optimization, intraoperative tranexamic acid, cell saver use, and blood-sparing techniques.
• Retrospective data from 20 craniofacial surgery patients served as controls.
• Prospective data was collected for patients managed by the PBM team.

Main Results:

• The transfusion rate decreased from 80% in the control group to 42% after PBM team implementation (P=0.007).
• During the final six months, the transfusion rate further dropped to 17%.
• Patients with von Willebrand disease were successfully managed, with only one requiring transfusion.

Conclusions:

• A dedicated PBM team effectively reduced blood transfusion needs in pediatric cranial vault surgery patients.
• The multimodal approach optimized hematologic management, minimizing transfusion-associated risks.
• This strategy is beneficial even for complex cases, including those with von Willebrand disease.