Use and Outcomes Associated With a Clear Prime for Infants Undergoing Cardiac Surgery

The benefits of restricting blood transfusion at the time of cardiac surgery have been shown previously. Given the paucity of information in the pediatric population, we compared outcomes and use of a clear vs a blood prime.

The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate patients (2.5-12 kg) undergoing an index operation between January 1, 2016, and June 30, 2022 (versions 3.3 and 3.41). Demographics, intraoperative variables, and outcomes were investigated. Categorical variables were analyzed with χ² tests, and Mann-Whitney U tests were calculated for continuous variables. Statistical significance was set at P < .0571.

During the study period, there were 60,037 patients with a blood prime and 7875 patients with a clear prime. The clear prime cohort was larger (weight, 7.3 kg vs 5.8 kg; body surface area, 0.4 m² vs 0.3 m²) and older (380.2 days vs 198.0 days; all P < .0001. The blood prime group had more chromosomal abnormalities, nonchromosomal anatomic abnormalities, and any preoperative factor (all P < .0001). The clear prime cohort had a lower hematocrit, shorter time on a ventilator, shorter length of stay, and decreased complications (all P < .0001).

Clear prime use has increased and was associated with a shorter time ventilated, extubation in the operating room, and decreased length of stay. Further studies are needed to identify opportunities to enhance blood conservation.