Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation

Cholette, Jill M.; Swartz, Michael F.; Rubenstein, Jeffrey S.; Henrichs, Kelly; Wang, Hongyue; Powers, Karen S.; Daugherty, L. Eugene; Alfieris, George M.; Gensini, Francisco; Blumberg, Neil

doi:10.1016/j.athoracsur.2016.05.049

Cited by 62 publications

(81 citation statements)

References 38 publications

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“…, Cholette et al . ). Dose of pRBCs administered and the higher pre‐transfusion packed cell volume (PCV) were associated with increased risk for non‐survival in a retrospective study of dogs (Holowaychuk et al .…”

Section: Introductionmentioning

confidence: 97%

Exploration of risk factors for non‐survival and for transfusion‐associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

Martínez‐Sogues

Blois

Manzanilla

et al. 2020

J of Small Animal Practice

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Objectives To describe red blood cell transfusion practices and short‐term outcomes in anaemic cats. To determine clinical variables associated with non‐survival and transfusion‐related complications. Material and Methods In this retrospective study, blood bank records from the Ontario Veterinary College Health Science Centre (OVC‐HSC) were reviewed to identify cats that received packed red blood cells or whole blood from 2009 to 2017. We extracted cause of anaemia, history of previous transfusion, pre‐ and post‐transfusion packed cell volume, pre‐transfusion compatibility testing, volume and dose of blood product, age of red blood cell unit, transfusion‐associated complications and patient survival. Results A total of 450 transfusion events were recorded in 267 cats. Blood loss was the most common indication for blood transfusion (44.9%), followed by ineffective erythropoiesis (37.5%) and red blood cell destruction (22.5%). Transfusion‐associated complications occurred in 10.2% events and there was a 20.2% mortality after transfusion. Mean increase in packed cell volume 24‐hours after transfusion was greater in cats undergoing major cross‐match testing before transfusion (7.2%) versus those that did not (4.0%). Non‐survival was associated with higher packed cell volume before transfusion, low patient body temperature before transfusion, anaemia due to blood loss and number of transfusions administered. Older age of transfused blood units was associated with non‐survival and transfusion‐related complications. Clinical Importance This study was observational and so our analyses were exploratory, but suggest that major cross‐match before transfusion tended to have greater transfusion efficacy and transfusion of older blood products might have detrimental effects on survival.

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Section: Introductionmentioning

confidence: 97%

Exploration of risk factors for non‐survival and for transfusion‐associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

Martínez‐Sogues

Blois

Manzanilla

et al. 2020

J of Small Animal Practice

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“…As a result, the increase of O 2 transport is countered by vasoconstriction and reduced blood flow through the microcirculation, and may not increase O 2 availability. Cholette et al reported similar O 2 extraction rates before and after transfusion in neonates. During their first week of life, neonates have a majority of fetal hemoglobin, which is a high‐O 2 ‐affinity hemoglobin (P 50 = 19.7 mm Hg).…”

Section: Blood Conservationmentioning

confidence: 79%

“…Among 23 neonates undergoing the arterial switch operation with a hemoglobin transfusion trigger of 7 g/dL, Redlin et al reported bloodless CPB in six and bloodless surgery in another six . Recently, Cholette et al reported similar lactate concentrations and clinical outcomes in neonates with hemoglobin concentrations as low as 7 g/dL for biventricular repair and 9 g/dL for palliative procedures (including Norwood procedures), when compared with neonates in whom hemoglobin concentrations were kept above 12 g/dL. On a larger scale, a retrospective analysis of 854 patients, including neonates, showed no significant difference in mortality or severe morbidity in patients receiving “prophylactic” transfusions to maintain hematocrit >20% on CPB, compared with those who received asanguinous prime and only “therapeutic” transfusions after CPB …”

Section: Blood Conservationmentioning

confidence: 99%

“…Although RBC transfusions increase O 2 transport, there are situations where they may not increase O 2 availability for tissues, which in turn depends on the hemoglobin's affinity for O 2 . Experimental work demonstrated that transfusion of hemoglobin with low‐O 2 ‐affinity decreases functional capillary density and results in arteriolar vasoconstriction.…”

Section: Blood Conservationmentioning

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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“…Salvaging and administration of shed blood from the cell saver can significantly reduce the number of blood and blood product transfusions in the immediate post-operative period (32). Adopting a conservative RBC transfusion approach (transfusing a hemoglobin less than 7.0 g/dL for biventricular repairs or less than 9.0 g/dL for palliative procedures plus clinical indication) has been shown to be effective in reducing RBC transfusion while showing no significant differences in lactate, avO 2 diff, or clinical outcomes (33).…”

Section: The Need and Problems Of Rbc Transfusion During Neonatal Carmentioning

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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Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation

Cited by 62 publications

References 38 publications

Exploration of risk factors for non‐survival and for transfusion‐associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

Exploration of risk factors for non‐survival and for transfusion‐associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

Recent achievements and future developments in neonatal cardiopulmonary bypass

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

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