Strategies for blood conservation in pediatric cardiac surgery

Singh, Sarvesh Pal

doi:10.4103/0971-9784.191562

Cited by 8 publications

(7 citation statements)

References 99 publications

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“…Intraoperative cell salvage has been shown to be a very safe and effective technique in reducing postoperative allogeneic blood transfusion and associated cost in pediatric cardiac surgical patients. 14,[46][47][48][49] Intraoperative cell salvage was not feasible for a long time in pediatric patients due to technical limitations mostly related to small volume of shed blood to be expeditiously processed for transfusion. There has been new generation of pediatric autotransfusion devices with small volume centrifugal bowls (49-55 mL) which will allow efficient blood salvage with hematocrit product ranging from 44% to 81% in small children.…”

Section: Operative Stagementioning

confidence: 99%

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

Karimi

2022

World J Pediatr Congenit Heart Surg

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Blood conservation practice in pediatric cardiac surgery has not been consistently adopted as quality improvement in many centers despite known risks associated with allogeneic blood products, shortage of donors, and costs. There are many blood conservation strategies available which collectively minimize exposure to allogeneic transfusion by maximizing the use of autologous red cells. These strategies are safe, reproducible, and have been implemented in clinical practice collectively with great efficacy for all patient ages and complexity levels. Institutional commitment to a set guideline will improve their blood conservation practice and quality outcome. The purpose of this article is to provide early career and practicing congenital cardiac surgeons with practical information concerning blood conservation strategies which can be considered for implementation in any pediatric cardiac surgery program, and which may be of particular value in resource-limited programs.

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Section: Operative Stagementioning

confidence: 99%

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

Karimi

2022

World J Pediatr Congenit Heart Surg

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Section: Introductionmentioning

confidence: 99%

“…3,4 Studies have shown that the use of an autotransfusion device can significantly reduce donor red cell and coagulant product transfusion while also providing cost savings during cardiac surgery within the pediatric population. [5][6][7][8][9] There are several devices available for cell salvage and each has distinct features and advantages within a pediatric cardiac surgical practice. The three that were selected for this comparison were the Sorin Xtra ® (LivaNova USA Inc, Arvada, CO), Fresenius Continuous Autotransfusion System (CATS ®plus ) (Fresenius Kabi AG, Hamburg, Germany) and Fresenius CATSmart ® (Fresenius Kabi AG, Hamburg, Germany).…”

Section: Introductionmentioning

confidence: 99%

Comparison of three autotransfusion devices for utilization in the pediatric population

et al. 2020

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Introduction: A device that may help attenuate the amount of homologous blood product given to pediatric cardiac surgical patients is the autotransfusion device. Three separate autotransfusion devices were selected for evaluation. The Sorin Xtra, Fresenius Continuous Autotransfusion System Plus (CATS*plus), and the Fresenius Continuous Autotransfusion System Smart (CATSmart) were evaluated based on the mechanical processes of each device, hematocrit value of the salvaged packed red cell product, time of processing, and the advantageous accessories with each device. Methods: Each of the autotransfusion devices were used to collect salvageable blood from the surgical field as well as to process residual blood from the cardiopulmonary bypass circuit after decannulation. The cell salvage process was performed in accordance with the manufacturer’s instructions for use and the recommended settings for processing and washing. The Sorin Xtra device had the 55 mL bowl set up for all cases, while the Fresenius continuous autotransfusion systems utilized the standard disposable for each device. Results: Each cell salvage device was employed during 30 pediatric cardiac surgery procedures, and data for each device, was broken down into four groups based on patient weight (0-10, 10-20, 20-40, and >40 kg). For all patient sizes, the Sorin Xtra tended to produce the greatest volume of cell saver product (55-825 mL) as compared to the CATS*plus and CATSmart devices (7-550 mL and 0-860 mL, respectively). The Continuous Autotransfusion System Smart tended to produce the highest hematocrit product, ranging from 44 to 81%. Discussion: Through this evaluation, it was determined the continuous autotransfusion systems provided the highest hematocrit with the lowest recovered packed red cell volume, while the Sorin Xtra packed red cell product showed to have a lower hematocrit with a larger packed red cell volume. Each device proved effective within our pediatric population.

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“…Despite these challenges, it is increasingly recognized that many children with CHD, however vulnerable, can be safely managed with conservative blood management practices. 4 Anemia in pediatric cardiac surgery is primarily related to hemodilution from CPB priming solutions, intravenous fluids, coagulation status changes and operative bleeding. Anemia tolerance, bleeding risk and transfusion therapy are influenced by various factors including patient age and weight, surgical complexity, operative duration, degree of cyanosis and coagulopathies induced by CPB.…”

Section: Introductionmentioning

confidence: 99%

<p>Minimizing the need for transfusion in pediatric congenital heart surgery</p>

Canêo¹,

Matte²,

Frey³

2019

IJCTM

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Blood conservation has become an essential institutional initiative in cardiac surgery patients secondary to published reports associating transfusion with increased morbidity and mortality. Cardiopulmonary bypass (CPB) for children with congenital heart disease presents unique challenges in regard to transfusion practice. The circuit size relative to the pediatric patient's circulating blood volume results in more hemodilution forcing clinicians to adopt several strategies to counteract this. It is generally agreed that the effects of hemodilution in this population are less well understood. That being said, there is evidence that neurologic outcomes are impacted by significant anemia in neonates and infants undergoing CPB. This adds to the level of concern clinicians should have when managing congenital heart surgery patients. Optimized surgical outcomes are dependent on neurologic outcomes. Specific transfusion guidelines for pediatric cardiac surgery still vary widely across institutions, and a safe minimum hematocrit on bypass has not been established. Evidence-based guidelines are more prevalent in adult cardiac surgery patients, but there are a growing number of reports for pediatrics. Clearly, well-defined operative strategies and a team approach will decrease blood product transfusions and minimize the associated risks in pediatric patients, especially in regard to neurologic outcomes. The ongoing development of evidence-based guidelines for pediatric perfusion will serve clinicians, and most importantly, their patients, well. The purpose of this review is to present current practice to limit blood transfusions in pediatric cardiac surgery exclusively inside the operating room and related to CPB as well as minimizing the side effects of the coagulation disturbances caused by the level of hemodilution these patients may encounter.

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Strategies for blood conservation in pediatric cardiac surgery

Cited by 8 publications

References 99 publications

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

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

Comparison of three autotransfusion devices for utilization in the pediatric population

<p>Minimizing the need for transfusion in pediatric congenital heart surgery</p>

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