Red blood cell transfusion threshold after pediatric cardiac surgery

Deng, Xicheng; Wang, Yefeng; Huang, Peng; Luo, Jinwen; Xiao, Yunbin; Qiu, Jun; Yang, Guangxian

doi:10.1097/md.0000000000014884

Cited by 12 publications

(3 citation statements)

References 48 publications

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“…A previous meta-analysis of four studies suggested that a restrictive transfusion strategy is non-inferior to a liberal transfusion strategy in pediatric cardiac surgery [13]. However, this study has a limitation.…”

Section: Introductionmentioning

confidence: 76%

Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis

et al. 2021

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This study aimed to compare the effects of restrictive and liberal red blood cell (RBC) transfusion strategies on pediatric patients undergoing cardiac surgery, including cyanotic and non-cyanotic children. A literature search of the MEDLINE, EMBASE, PubMed, and the Cochrane Library database was conducted. Meta-analyses were carried out comparing restrictive and liberal transfusion strategies. Subgroup analyses were performed based on the basis of cyanotic status. Five randomized controlled trials with a total of 497 children were included. There was no significant difference in the risk of in-hospital mortality between the two transfusion strategies (risk ratio 1.21; 95% confidence interval 0.49 to 2.99; P = 0.68). The trial sequential analysis suggested that the current meta-analysis had an absence of evidence for in-hospital mortality, and the data were insufficient. Moreover, no significant differences existed between groups in terms of risk of infection, blood loss, duration of mechanical ventilation, pediatric intensive care unit (PICU) stay duration, or hospital stay duration. Cyanotic children treated with a liberal transfusion strategy had a shorter ventilator duration, but the transfusion strategy did not affect in-hospital mortality, infection, hospital stay, or PICU stay duration. On the basis of the available data, our analysis indicates that a liberal transfusion strategy did not lead to a better outcomes, but the data are extremely sparse, which highlights the need for clearer transfusion guidelines specific to this specific population. Trial registration number CRD42018102283.

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Section: Introductionmentioning

confidence: 76%

Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis

et al. 2021

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“…10,14,15 However, two subsequent meta-analyses comparing "restrictive" and "liberal" packed red blood cell transfusion strategies during paediatric cardiac surgery found no significant difference in risk of in-hospital mortality, infection, blood loss, duration of mechanical ventilation, or length of stay. 16,17 Furthermore, subgroup analysis of patients with cyanotic CHD treated with "liberal" transfusion strategy demonstrated a significantly shorter duration of post-operative mechanical ventilation. 16 Regarding efficacy, outcome measures focusing on oxygen delivery biomarkers such as lactate and mixed venous oxygen saturation (SvO 2 ) have failed to find consistent benefit from packed red blood cell transfusion transfusion after paediatric cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture

Mikulski,

Linero,

Stromberg

et al. 2024

Cardiol Young

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Background: Packed red blood cell transfusions occur frequently after congenital heart surgery to augment haemodynamics, with limited understanding of efficacy. The goal of this study was to analyse the hemodynamic response to packed red blood cell transfusions in a single cohort, as “proof-of-concept” utilising high-frequency data capture of real-time telemetry monitoring. Methods: Retrospective review of patients after the arterial switch operation receiving packed red blood cell transfusions from 15 July 2020 to 15 July 2021. Hemodynamic parameters were collected from a high-frequency data capture system (SickbayTM) continuously recording vital signs from bedside monitors and analysed in 5-minute intervals up to 6 hours before, 4 hours during, and 6 hours after packed red blood cell transfusions—up to 57,600 vital signs per packed red blood cell transfusions. Variables related to oxygen balance included blood gas co-oximetry, lactate levels, near-infrared spectroscopy, and ventilator settings. Analgesic, sedative, and vasoactive infusions were also collected. Results: Six patients, at 8.5[IQR:5-22] days old and weighing 3.1[IQR:2.8-3.2]kg, received transfusions following the arterial switch operation. There were 10 packed red blood cell transfusions 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]. Significant increases in systolic and mean arterial blood pressures by 5-12.5% at 3 hours after packed red blood cell transfusions were observed, while renal near-infrared spectroscopy increased by 6.2% post-transfusion. No significant changes in ventilation, vasoactive support, or laboratory values related to oxygen balance were observed. Conclusions: Packed red blood cell transfusions given after the arterial switch operation increased arterial blood pressure by 5-12.5% for 3 hours and renal near-infrared spectroscopy by 6.2%. High-frequency data capture systems can be leveraged to provide novel insights into the hemodynamic response to commonly used therapies such as packed red blood cell transfusions after paediatric cardiac surgery.

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“…To counteract possible negative consequences of severe anemia for infants following surgery of congenital heart disease, red blood cell (RBC) transfusions are commonly administered to replace blood loss with the intention to optimize oxygen delivery or to achieve favorable hemodynamic conditions [5,7]. However, there is an increasing number of studies showing negative impact of RBC transfusions on PICU stay, length of mechanical ventilation, postoperative infections, organ dysfunction, and mortality [3,4,8,10,13,23,26].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Blood-Saving Program in a Pediatric Intensive Care Unit to Reduce Diagnostic Blood Loss

et al. 2020

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Background We aimed to reduce blood loss in the pediatric critical care unit (PICU) due to blood sampling in neonates and infants. Therefore, an educational program for our staff was established and evaluated. Methods Patients in a PICU of a tertiary referral center aged 0–12 months who underwent surgery of congenital heart disease on cardiopulmonary bypass were enrolled and divided into a pre- and a post-implementation group. We assessed frequency and types of postoperative blood samples, required blood volume, and amount of blood transfusions in the PICU within 5 days after cardiac surgery. Results Populations were similar prior and after the implementation. Blood drawn for blood gas analysis (0,52 ml±0,16 vs. 0,38 ml±0,12, p<0,001) and for complete blood sampling (2,62 ml±0,32 vs. 2,11 ml±0,35, p<0,001) could be successfully reduced after implementation of our blood-saving program. The daily diagnostic blood loss per patient was significantly reduced by approximately 35% (1,7 ml/kg/d±1,0 vs. 1,1 ml/kg/d±0,7, p=0,008). Discussion Our quality improvement program is feasible and effective to significantly reduce the blood loss due to blood sampling. Although the incidence of red blood cell transfusions was not significantly reduced, it is certainly beneficial to try to reduce diagnostic blood loss, especially in children with complex diseases requiring long-term intensive care treatment. Conclusion We could demonstrate that it is possible to significantly reduce the blood loss due to blood sampling with a simple educational program for PICU staff.

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Red blood cell transfusion threshold after pediatric cardiac surgery

Cited by 12 publications

References 48 publications

Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis

Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis

Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture

Implementation of a Blood-Saving Program in a Pediatric Intensive Care Unit to Reduce Diagnostic Blood Loss

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