Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

Abstract

Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). In the MP group, narrow-caliber (3/16″) tubing was used, and the pump heads were vertically aligned to shorten the tubing lengths. The smallest possible oxygenators and hemofilters were used, and vacuum drainage was applied. Ultrafiltration was vigorously applied during CPB to avoid excessive hemodilution. The mean age and body weight of the patients were 48 ± 41 (0-306) days and 3.8 ± 0.8 (1.3-5.0) kg, respectively. The total priming and transfusion volumes during CPB were lower in the MP group than in the CP group (141 ± 24 mL vs. 292 ± 50 mL, P< 0.001, and 82 ± 40 mL vs. 162 ± 82 mL, P < 0.001, respectively). In the MP group, the smallest priming volume was 110 mL. However, there was no significant difference in the lowest hematocrit level during CPB between the two groups (22 ± 3% vs. 22 ± 3%, P = 0.724). The incidence of postoperative neurological complications was not significantly different between the MP and CP groups (1.8% vs. 2.7%, P = 0.509). After adjustment for the Risk Adjustment for Congenital Heart Surgery category, body surface area, and age, MP was not an independent risk factor of postoperative neurological complications or early mortality (P = 0.213 and P = 0.467, respectively). The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.

Effects of Mini‐Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low‐Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support

“…We have already reported our experience with infants whose bodyweight was under 5 kg. In the report, we have shown that minimized priming volume can be used without significant risk for postoperative morbidity, with avoidance of pRBC transfusion during CPB (4). Similar benefits associated with transfusion during CPB have also been proven, and additional clinical implication has been demonstrated in the present study.…”

“…Associated with these systemic effects of CPB, reduction in priming volume has been attempted in many centers, and favorable outcomes, including reduction of allogeneic transfusion requirements and avoidance of acute kidney injury, have been reported (3). We also previously announced our experience with mini-volume priming (MP) in pediatric patients, which demonstrated blood sparing via CPB without increasing the risk of morbidity or mortality in infants whose bodyweight was 5 kg or less (4). By minimizing priming volume, we were able to reduce the dilution of autologous blood and contact with foreign surfaces.…”

Evaluation of Different Diameter Arterial Tubing and Arterial Cannulae in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits

“…But in children, the priming volume is relatively large in relation to patient size and blood volume, as much as 200-300% in neonates (1). By far, CPB procedure for neonates and infants remains a major challenge for clinicians (2).…”

Cardiopulmonary Bypass Priming Using Autologous Cord Blood in Neonatal Congenital Cardiac Surgery

“…The mini-volume priming methods and cardiopulmonary bypass strategy in our institution have been previously described. 10) The volume of cord whole blood used for priming fluid was calculated based on the preoperative hematocrit (HCT) level, as follows:…”