Blood Conservation Operations in Pediatric Cardiac Patients: A Paradigm Shift of Blood Use

Karimi, Mohsen; Florentino-Pineda, Ivan; Weatherred, Ted; Qadeer, Ahsan; Rosenberg, Carol A.; Hudacko, Andrea; Ryu, Dongseok

doi:10.1016/j.athoracsur.2012.09.029

Cited by 36 publications

(36 citation statements)

References 16 publications

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“…In recent years, as a result of the accumulation of data suggesting an association between RBC transfusion and increased postoperative morbidity, a greater emphasis has been placed on blood conservation during pediatric cardiac operations [27]. Several strategies have been successfully used to reduce the need for postoperative RBC transfusion.…”

Section: Commentmentioning

confidence: 99%

Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Mazine

Rached-d’Astous

Ducruet

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Mazine

Rached-d’Astous

Ducruet

et al. 2015

The Annals of Thoracic Surgery

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“…Similarly, a comprehensive intraoperative blood-sparing approach that resulted in no transfusion in 25% of children undergoing cardiac operations compared with children who received a transfusion during the surgery demonstrated a shorter length of postoperative mechanical ventilation and a shorter PICU stay[21]. This has also been demonstrated that blood conservation in pediatric cardiac surgery was associated with a decrease in post-operative inotropic needs, days on ventilator, and length of stay in patients with biventricular physiology[22]. …”

Section: Discussionmentioning

confidence: 99%

Blood conservation pediatric cardiac surgery in all ages and complexity levels

Karimi¹,

Sullivan²,

Linthicum³

et al. 2017

WJC

Self Cite

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AIMTo demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODSWe retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) from 2010-2015. The patients were grouped into blood conservation (n = 138) and non-conservation (n = 218) groups and sub-grouped based on their ages and procedural complexity scores.RESULTSThere were no statistical differences in gender, weight, pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups, there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels.CONCLUSIONBlood conservation surgery can be performed in congenital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.

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“…Some also demonstrate or suggest an increase in postoperative mortality (13)(14)(15)(16)(17). Some also demonstrate or suggest an increase in postoperative mortality (13)(14)(15)(16)(17).…”

Section: Transfusion Of Rbcsmentioning

confidence: 99%

Use of Blood Products in Pediatric Cardiac Surgery

Durandy

2015

Artificial Organs

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In pediatric cardiac surgery, there is a substantial gap between published recommendations or guidelines for blood product use and clinical practice. The drawbacks of blood transfusion are well acknowledged though. The aim of this paper is to present the rationale for packed red blood cells, fresh frozen plasma (FFP), and platelets used in pediatric patients. Blood hemoglobin level is the current trigger used for packed red blood cells transfusion, though commonly admitted to be suboptimal. An increase in hemoglobin level is likely to be associated with an increase in blood oxygen content and blood oxygen delivery. However, above a critical level of hemoglobin, normovolemic anemia is well tolerated, and any increase in hemoglobin will fail to increase oxygen consumption and therefore to improve end-organ oxygen supply. FFP is one way to address the coagulation factors deficiency induced by hemodilution, consumption, or hepatic insufficiency. The volume needed to increase these factors is not negligible. To avoid dilution and/or fluid overload, the use of clotting factor concentrate is recommended. The same remark can be made regarding the treatment of antithrombin III deficiency. Platelets infusion should be restricted to bleeding patients with thrombocytopenia and without surgical bleeding. In clinical studies, the prevention of bleeding through prophylactic infusion of platelets proved to be useless. Optimizing the use of blood products (avoiding overuse, underuse, and inappropriate use) is a challenging task in pediatric cardiac surgery. Data or guidelines cannot replace clinical judgment and the decision to transfuse is left to individual discretion, but the medical community needs to optimize its transfusion practice, otherwise policy-makers without similar expertise may step in to regulate the use of blood products.

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Blood Conservation Operations in Pediatric Cardiac Patients: A Paradigm Shift of Blood Use

Cited by 36 publications

References 16 publications

Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Blood conservation pediatric cardiac surgery in all ages and complexity levels

Use of Blood Products in Pediatric Cardiac Surgery

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