Blood conservation pediatric cardiac surgery in all ages and complexity levels

Abstract

AIMTo demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODSWe retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) from 2010-2015. The patients were grouped into blood conservation (n = 138) and non-conservation (n = 218) groups and sub-grouped based on their ages and procedural complexity scores.RESULTSThere were no statistical differences in gender, weight, pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups, there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels.CONCLUSIONBlood conservation surgery can be performed in congenital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

“…As mentioned in clinical practice guideline 6.2, patient blood management programs have been developed across institutions, with the goal of reducing the number and volume of RBC transfusions and donor exposures in children undergoing cardiac surgery. Advances in anesthesia management, CPB techniques, monitoring and point-of-care testing have allowed for significant reduction in blood product transfusions in those institutions adopting blood conservation practices (75, 76) and appear to demonstrate improved clinical outcomes (77). Miniaturization of the CPB circuit (31), smaller priming volumes (78) and hemoconcentration methods (35, 36) and re-infusion of cell saver blood (79, 80) has been proven to decrease intra and post-operative blood transfusions.…”

Efectos del tratamiento sanguíneo del paciente en cirugía cardíaca pediátrica

“…Hemodilution under CPB can potentially lower the perfusion pressure, increasing the risk of neurological complications after CPB. If the cerebral blood flow increases to enhance the perfusion pressure, the number of microembolisms reaching the brain increases and the oxygen supply to neurons diminishes 17 . We reduced neurological complication rates and the need for blood products by reducing the perioperative use of crystalloids in our patients.…”

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

“…By the same token, patients with univentricular physiology can be managed with hematocrit > 30% during CPB and hematocrit > 35% after CPB while adhering to acceptable hemodynamic parameters without adverse perioperative outcomes utilizing conventional conservation methods. 9,11,16,17 A lower hematocrit can also be tolerated by a compensatory higher perfusion flow and adjusting pCO 2 to provide satisfactory end organ perfusion without further adding blood to the circuit. Transfusion of red blood cell outside the trigger points are indicated when there is no improvement in SVO 2 , cerebral saturation (drop by 20% from baseline), and rising lactate level after optimizing the flow rate and pCO 2 during CPB.…”

“…[3][4][5][6][7][8] There is convincing evidence that blood conservation practice in pediatric cardiac surgery can be performed in all age groups and complexity categories with improved outcomes by using wellaccepted multimodality methods and conventional conservation protocols and guidlines. [9][10][11][12][13][14][15] This article describes and discusses a variety of blood conservation strategies and technologies based on the author's experience with blood conservation practice over more than a decade. In addition, it provides supportive information from peer-reviewed literature.…”