Red cell transfusion management for patients undergoing cardiac surgery for congenital heart disease

Wilkinson, Kirstin; Brunskill, Susan J; Dorée, Carolyn; Murphy, Mike; Hopewell, Sally; Gill, Ravi

doi:10.1002/14651858.cd009752

Cited by 15 publications

(20 citation statements)

References 62 publications

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“…This, however, remains a subject of debate, and a meta-analysis of 11 trials in congenital cardiac surgery could not accurately assess the impact of RBC transfusions on children undergoing cardiac surgery. 2 An efficient blood-sparing approach involves all of the contributors to the surgical performance: a meticulous surgical technique aimed to minimize blood loss, reduction of the priming volume, predefined transfusion trigger and monitoring of regional circulations for the detection of hypoxia, hemoconcentration and cell-salvage for retransfusion of autologuous RBC, and avoidance of unnecessary blood sampling.…”

Section: Blood Conse Rvationmentioning

confidence: 99%

“…Importantly, the mean perfusion pressure had poor correlation with the flow rate. To emphasize the importance of such a multimodal monitoring strategy, they showed that 14 of 34 patients had cerebral rSO2 of 95%, placing them at risk for cerebral hyperperfusion if the cerebral rSO 2 had been used alone to guide bypass flow. Finally, in order to minimize the need for deep hypothermia, surgeons are experimenting with moderately hypothermic splanchnic perfusion during reconstruction of the aortic arch.…”

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confidence: 99%

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Recent achievements and future developments in neonatal cardiopulmonary bypass

Bojan

2019

Pediatric Anesthesia

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Summary A primary goal of improving neonatal cardiopulmonary bypass has been making the circuit smaller and reduce the blood contacting surfaces. As bypass circuit size has decreased, bloodless surgery has become possible even in neonates. Since transfusion guidelines are difficult to construct based on existing literature, these technical advances should be taken advantage of in conjunction with an individualized transfusion scheme, based on monitoring of oxygen availability to the tissues. For the majority of neonatal heart operations, several centers have shifted toward normothermic bypass even for complex neonatal surgeries, in order to avoid the adverse effects of hypothermia. Deep hypothermic circulatory arrest is no longer a necessity but an option, and selective antegrade cerebral perfusion has become common practice; however, technical uncertainties with regard to this technique have to be addressed, based on reliable neurologic monitoring. Maintenance of patient‐specific heparin concentrations during bypass is another key goal, since neonates have lower baseline antithrombin concentrations and, therefore, a higher risk for inadequate thrombin inhibition and postoperative bleeding. Due to the immaturity of their hemostatic system, the standard coagulation tests alone are inappropriate to guide hemostatic therapy in neonates. The use of indirect heparin concentration assays and global viscoelastic assays in the operating room is likely to represent the optimal strategy, and requires validation in neonates. Monitoring of global and regional indexes of oxygen availability and consumption on bypass have become possible; however, their use in neonates still has outstanding technical issues which should be addressed and hence needs further validation. Due to the immaturity of the neonatal myocardium, single‐shot cold cardioplegia solutions are thought to confer the best myocardial protection; their superiority when compared to more conventional modalities, however, remains to be demonstrated.

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Section: Blood Conse Rvationmentioning

confidence: 99%

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confidence: 99%

Recent achievements and future developments in neonatal cardiopulmonary bypass

Bojan

2019

Pediatric Anesthesia

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“…Although integral, there are risks associated with RBC transfusions that can translate into increased patient morbidity and mortality (1).…”

Section: Techniques and Technologies To Minimize Blood Transfusionmentioning

confidence: 99%

“…Transfusion medicine has improved vastly and the focus has shifted to adverse transfusion reactions such as acute lung injury, immunomodulation, and thrombotic complications (1)(2)(3). With focus increasing on these risks, centers have reevaluated RBC administration algorithms, especially for neonate and infant populations due to having a higher incidence of adverse reactions compared to older pediatric and adult patient populations (1,4). To reduce the potential exposure and risks associated with RBC transfusions, there are practices that can be put in place in the intraoperative period.…”

Section: Recent Innovations In Perfusion and Cardiopulmonary Bypass Fmentioning

confidence: 99%

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer¹,

Beaty²,

Clingan³

et al. 2018

Transl Pediatr

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Abstract:The development and refinement of cardiopulmonary bypass (CPB) has made the repair of complex congenital heart defects possible in neonates and infants. In the past, the primary goal for these procedures was patient survival. Now that substantial survival rates have been achieved for even the most complex of repairs in these patients, focus has been given to the reduction of morbidity. Although a necessity for these complex neonatal and infant heart defect repairs, CPB can also be an important source of perioperative complications. Recent innovations have been developed to mitigate these risks and is the topic of this review. Specifically, we will discuss improvements in minimizing blood transfusions, CPB circuit design, monitoring, perfusion techniques, temperature management, and myocardial protection, and then conclude with a brief discussion of how further systematic improvements can be made in these areas.

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“…What are optimal RBC transfusion strategies for anemia not related to acute hemorrhage in children who undergo surgery? [49][50][51] Data supporting RBC transfusion strategies for critically ill children undergoing surgical procedures (e.g., traumatic brain injury, congenital heart disease, liver transplant, spinal surgery) are limited, mainly retrospective, and single center. These surgical procedures are conducted in medically fragile patients whose complicated physiology, including altered vasomotor autonomic regulation, existing coagulopathy, myocardial depression, and/or varying degree of desaturation, may impair adaptive physiologic responses to shock (oxygen debt).…”

Section: Devices and Surgerymentioning

confidence: 99%

2016 proceedings of the National Heart, Lung, and Blood Institute's scientific priorities in pediatric transfusion medicine

et al. 2017

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have the potential to transform the clinical practice of pediatric transfusion medicine. By applying basic, translational, and/or clinical research studies focused in six areas the science of transfusion medicine would be advanced. The six areas were selected based on recognized gaps in knowledge and included neonatology and perinatology, oncology and transplant, chronic transfusion, devices and surgery, intensive care, and trauma and teenage blood donation. The meeting and premeeting teleconferences included 80 participants representing multiple stakeholders, academic medicine, the basic and clinical research community, and the government. The participants had expertise in multiple relevant disciplines including transfusion medicine, pediatrics, neonatology, hematology, surgery, critical care, trauma, internal medicine, epidemiology, and study design. The speakers and participants identified research priorities based on unmet needs in the pediatric transfusion medicine arena and proposed strategies to overcome the knowledge gaps and address unanswered questions. ABBREVIATIONS: ECMO 5 extracorporeal membrane oxygenation; HSCT 5 hematopoietic stem cell transplant; ICU 5 intensive care unit; MRI 5 magnetic resonance imaging; NHLBI 5 5 National Heart, Lung, and Blood Institute; NICHD 5 National Institute of Child Health and Human Development; NISHOT 5 noninfectious serious hazards of transfusion; PICU 5 pediatric intensive care unit; PRT 5 pathogen reduction technology; REDS 5 Recipient Epidemiology and Donor Evaluation Study; SCD 5 sickle cell disease; VAD 5 ventricular assist device. From the

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Red cell transfusion management for patients undergoing cardiac surgery for congenital heart disease

Abstract: Red cell transfusion management for patients undergoing cardiac surgery for congenital heart disease.

Cited by 15 publications

References 62 publications

Recent achievements and future developments in neonatal cardiopulmonary bypass

Recent achievements and future developments in neonatal cardiopulmonary bypass

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

2016 proceedings of the National Heart, Lung, and Blood Institute's scientific priorities in pediatric transfusion medicine

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