Use of whole blood in pediatric congenital heart surgery

Cardiopulmonary bypass is necessary for surgical repair of complex congenital heart disease. We studied whether whole blood use in circuit prime and for initial intraoperative transfusion needs improved postoperative outcomes in infants less than 2 months of age.

This was a single-center retrospective chart review of infants who underwent cardiac surgery using cardiopulmonary bypass between May 2019 and February 2023. We reviewed and analyzed intraoperative and postoperative variables for whole blood and standard blood prime use in patients, whereas the remainder of clinical management stayed unchanged.

Ninety-five patients were included in our analysis. Donor exposure was reduced in the whole blood group with a median of 3 donors (Q1-Q3: 2-4) compared with the standard group with 5 donors (Q1-Q3: 5-6, P < .001). The whole blood cohort used whole blood for intraoperative transfusion needs over individual blood components. Whole blood recipients had lower postoperative platelet counts and fibrinogen levels, but no clinical markers of increased postoperative bleeding compared with the standard group. There was no statistically significant difference in length of stay, mechanical ventilation days, postoperative transfusion requirements, or time to delayed sternal closure between groups.

The whole blood cohort was found to have fewer donor exposures and less intraoperative individual blood component use but no difference in postoperative outcomes. Continued research must be pursued to understand if whole blood with new circuit techniques and hemostatic interventions can reduce transfusion needs and lead to superior results.