Analysis of Hemodynamics During Blood Transfusion Utilizing High-Fidelity Realtime Telemetry After the Arterial Switch Operation

Abstract

Background Red blood cell transfusions (pRBCTx) are given to many patients after congenital heart surgery to augment hemodynamics, but our current understanding is limited by hourly vital sign recordings. The goal of this study was to analyze hemodynamic parameters surrounding pRBCTx with high-fidelity, real-time telemetry monitoring.Methods This is a retrospective review of patients after the arterial switch operation receiving post-operative pRBCTx from 07/15/2020-07/15/2021. Continuous, 1-Hz vital sign data were analyzed in five-minute intervals up to six hours before, four hours during, and six hours after pRBCTx—up to 57,600 data points per pRBCTx. Oxygen delivery was assessed using pre- and post-pRBCTx laboratory data, hourly renal and cerebral near-infrared spectroscopy, sedation medication doses, and vasoactive-inotropic scores.Results Six patients, median age 8.5[IQR:5–22] days and weight 3.1[IQR:2.8–3.2]kg, underwent the arterial switch operation. There were 10 pRBCTx administered with a median dose of 10[IQR:10–15]mL/kg over 169[IQR:110–190]min; at median post-operative hour 36[IQR:10–40]. There was an increase in systolic and mean arterial blood pressures by 5-12.5% at three hours after pRBCTx, but returned to baseline at six hours. There were no changes in heart rate or oxygen saturations. Renal spectroscopy increased by 6.2% after pRBCTx. There were no changes in ventilation, sedation, vasoactive support, or laboratory variables related to oxygen delivery.Conclusions pRBCTx given to arterial switch operation patients increases arterial blood pressures three hours post-pRBCTx without evidence of sustained effects at six hours. High-fidelity real-time data can be used to better assess hemodynamic parameters after congenital heart surgery and provide nuanced, patient-specific care.