RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

Savorgnan, Fabio; Bhat, Priya; Checchia, Paul A.; Acosta, Sebastián; Tume, Sebastian C.; Lasa, Javier J.; Asadourian, Vicken; Achuff, Barbara-Jo; Flores, Saúl; Ahmed, Mubasheer; Crouthamel, Daniel I; Loomba, Rohit S.; Bronicki, Ronald A.

doi:10.1097/cce.0000000000000417

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…Low systemic vascular resistance with high cardiac output has been demonstrated as the physiologic state associated with the lowest likelihood to be associated with poor outcomes in parallel circulation [23]. Thus, interventions to decrease systemic vascular resistance and increase cardiac output lead to optimization of systemic oxygen delivery and clinical outcome [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. In the current study, systemic oxygen delivery was quanti ed using the renal oxygen extraction ratio calculated using renal near infrared spectroscopy.…”

Section: Resultsmentioning

confidence: 99%

Clinical parameters to predict adverse outcomes in patients with parallel circulation with a Blalock-Taussig-Thomas shunt

Sheth¹,

Loomba²

2022

Preprint

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Introduction In patients with parallel circulation, early risk factor identification for adverse outcome can facilitate prevention. This retrospective study compares vital sign parameters, near infrared spectroscopy, central venous pressure, hemoglobin, serum lactate, and vasoinotrope score in the first 48 hours between those with parallel circulation with and without a composite adverse outcome after Blalock-Taussig-Thomas shunt placement. Methods Hemodynamic variables were collected at the following postoperative timepoints: admission to the cardiac intensive care unit, 6 hours, 12 hours, 24 hours, and 48 hours after. Outcomes of interest included cardiopulmonary arrest, need for extracorporeal membrane oxygenation, or inpatient mortality during the admission. Results Of the 39 neonates in the study, 10 experienced the composite outcome. Four variables had a receiver operator curve analysis area under the curve of > 0.60. The resulting risk score was as follows, with 1 point being assigned for a central venous pressure greater than 7.8, 1 point for a serum lactate greater than 1.8, renal oxygen extraction ratio of greater than 32, and vasoinotrope score of greater than 8.7. A score of 0 was associated with a 0% risk of the composite outcome, a score of 1 or 2 a 15% risk, and a score of 3 or 4 a 60% risk. Conclusion A combination of increased central venous pressure, increased serum lactate, increased renal oxygen extraction ratio, and increased vasoinotrope score are highly accurately associated with risk of cardiopulmonary arrest, need for extracorporeal membrane oxygenation, or inpatient mortality after a Blalock-Taussig-Thomas shunt in patients with parallel circulation.

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Section: Resultsmentioning

confidence: 99%

Clinical parameters to predict adverse outcomes in patients with parallel circulation with a Blalock-Taussig-Thomas shunt

Sheth¹,

Loomba²

2022

Preprint

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“…14,19,20 A recent study detected a significant increase in ST segment variability with evidence of myocardial ischemia temporally associated with pRBC transfusions in neonates following the Norwood procedure. 21 In clinical practice, the relative transfused quantity of pRBC often differs between adults and children, whose ratio of total blood to transfusion volume is much higher, as the following example shows: according to the age-based modified total blood volume (TBV) calculation (TBV ¼ ideal body weight Â 70 mL/kg in patients under 65 years of age), 22 the estimated TBV of an adult with 80 kg body weight would be 5.6 L. In this scenario, for instance, the transfusion of a whole bag of pRBC (250-300 mL) would correspond to 4.5 to 5.4% of the TBV. By contrast, in a child with 5 kg body weight and an estimated TBV of 400 mL receiving the usual quantity of 20 mL/kg, the transfusion would account for 25% of their TBV.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study detected a significant increase in ST segment variability with evidence of myocardial ischemia temporally associated with pRBC transfusions in neonates following the Norwood procedure. 21 …”

Section: Discussionmentioning

confidence: 99%

Risk Assessment of Red Cell Transfusion in Congenital Heart Disease

Zürn

Hohn

Hübner

et al. 2022

Thorac Cardiovasc Surg

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Background The storage time of packed red blood cells (pRBC) is an indicator of change in the product's pH, potassium, and lactate levels. Blood–gas analysis is a readily available bedside tool on every intensive care ward to measure these factors prior to application, thus facilitating a calculated decision on a transfusion's quantity and duration.Our first goal is to assess the impact of storage time on pH, potassium, and lactate levels in pRBC. The influence of those parameters in the transfused children will then be evaluated. Methods In this retrospective study, we conducted blood–gas analyses of pRBC units before they were administered over 4 hours to neonates, infants, and children in our pediatric cardiac intensive care ward. All patients underwent regular blood–gas analyses themselves, before and after transfusion. Results We observed a highly significant correlation between the storage time of pRBC units and a drop in pH, as well as an increase in potassium and lactate of stored red cells (p< 0.0001). Median age of recipients with a complete blood–gas dataset was 0.1 (interquartile range [IQR] = 0.0–0.7) years; median pRBC storage duration was 6 (IQR = 5–8) days. Further analyses showed no statistically significant effect on children's blood gases within 4 hours after transfusion, even after stratifying for pRBC storage time ≤7 days and >7 days. Conclusion Stored red blood cells show a rapid decrease in pH and increase in potassium and lactate. Slow transfusion of these units had no adverse effects on the recipients' pH, potassium, and lactate levels.

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“…Meanwhile, Savorgnan, et al concluded there was "surrogate evidence of coronary ischaemia" during packed red blood cell transfusions based solely on increased ST segment-vector variability from baseline during the transfusion period, despite significantly decreased HR and increased diastolic pressures. 26 Not only were no oxygen delivery biomarkers included in this study, but the ST segment-vector significance was determined using an advanced HFDC algorithm unique to that institution that has not been validated elsewhere. 26 Sickbay ™ (Medical Informatics Corp, Houston, TX) is one such HFDC platform that continuously records numeric and waveform vital sign data across multiple standard monitoring and therapeutic devices.…”

Section: Introductionmentioning

confidence: 99%

“…26 Not only were no oxygen delivery biomarkers included in this study, but the ST segment-vector significance was determined using an advanced HFDC algorithm unique to that institution that has not been validated elsewhere. 26 Sickbay ™ (Medical Informatics Corp, Houston, TX) is one such HFDC platform that continuously records numeric and waveform vital sign data across multiple standard monitoring and therapeutic devices. 25,27 In addition to allowing real-time, secondto-second analysis, this platform has provided novel insights into patient response to therapy, such as time to arrhythmia cessation with IV sotalol and hypotension associated with IV acetaminophen.…”

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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RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

Abstract: Supplemental Digital Content is available in the text.

Cited by 8 publications

References 18 publications

Clinical parameters to predict adverse outcomes in patients with parallel circulation with a Blalock-Taussig-Thomas shunt

Clinical parameters to predict adverse outcomes in patients with parallel circulation with a Blalock-Taussig-Thomas shunt

Risk Assessment of Red Cell Transfusion in Congenital Heart Disease

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

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