Red Blood Cell Transfusion After Stage I Palliation Is Associated With Worse Clinical Outcomes

Abstract

Background Packed red blood cell transfusion may improve oxygen content in single‐ventricle neonates, but its effect on clinical outcomes after Stage 1 palliation is unknown. Methods and Results Retrospective multicenter analysis of packed red blood cell transfusion exposures in neonates after Stage 1 palliation, excluding those with intraoperative mortality or need for extracorporeal membrane oxygenation. Transfusion practice variability was assessed, and multivariable regression used to identify transfusion risk factors. After propensity score adjustment for severity of illness, clinical outcomes were compared between transfused and nontransfused subjects. Of 396 subjects, 323 (82%) received 930 postoperative red blood cell transfusions. Packed red blood cell volume (median 9–42 mL/kg [ P <0.0001]), donor exposures (1–2 [ P <0.0001]), transfusion number (1–3 [ P <0.0001]), and pretransfusion hemoglobin (12.1–13 g/dL, P =0.0049) varied between sites. Cyanosis ( P =0.02), chest tube output ( P =0.0003), and delayed sternal closure ( P =0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, P =0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, P =0.016). When stratified by number of transfusions (0, 1, or >1), duration of mechanical ventilation (3 [1, 5] versus 4 [3, 6] versus 9 [5, 16] days [ P <0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [ P <0.0001]) increased for those transfused more than once. Most subjects who died were transfused, though the association with mortality was not significant. Conclusions Packed red blood cell transfusion after Stage 1 palliation is common, and transfusion practice is variable. Transfusion is a significant predictor of longer intensive care unit stay and mechanical ventilation. Further studies to define evidence‐based transfusion thresholds are warranted.

Refraining from Packed Red Blood Cells in Cardiopulmonary Bypass Priming as a Method of Neuroprotection in Pediatric Cardiac Surgery

“…Our results are consistent with many other studies in which the negative effects of transfusion have been proven [ 45 ]. However, it should be taken into account that in our research, only the strategy of managing patients with septal congenital heart disease was studied.…”

RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

“…Cardiac surgery and the attendant myocardial ischemia reperfusion injury damage the coronary endothelium, impairing NO production and contributing to a decrease in NO bioavailability ( 9 ). Following the NP, the immature neonatal myocardium is particularly vulnerable to cardiac ischemia due to multiple factors including obligate cyanosis; increased cardiac demand due to the inefficiency of the parallel circulation and requirement for an elevated cardiac output; obligate retrograde aortic flow to coronary arteries arising from a diminutive, native ascending aorta; and in those undergoing the Blalock-Taussig shunt (BTS), diastolic hypotension and “coronary steal” resulting from diastolic “run-off” into the pulmonary circulation ( 3 , 11 , 16 ).…”

Association of Immediate Postoperative Hemodynamic and Laboratory Values in Predicting Norwood Admission Outcomes

“…Firm conclusions about packed red blood cell transfusions in the management of patients with parallel circulation cannot be made from the current data. Other studies have demonstrated con icting ndings [32][33][34][35][36].…”