Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

Abstract

This retrospective study analyzed the current practice of blood transfusion-free open-heart surgery in 536 children weighing 5-20 kg undergoing surgery between 2004 and 2007. A miniaturized cardiopulmonary bypass (CPB) circuit was used (priming volume; 300 ml for the flow rate <1,500 ml/min; 550 ml for the flow rate of 1500-2300 ml/min). Modified ultrafiltration was routinely performed. Criteria for blood transfusion during CPB included a hematocrit of <20% and/or mixed venous oxygen saturation of <65%. Transfusion during CPB was avoided in 264 (49.3%) of the 536 patients (5-10 kg group, 29.0%; 11-15 kg group, 67.4%; 16-20 kg group, 80.8%). There was no neurological complication related to hemodilution. Multiple logistic regression analysis revealed that body weight, preoperative hematocrit, priming volume of CPB circuit, CPB time, and lowest hematocrit during CPB predict requirement of blood transfusion (p < 0.01). Transfusion rate was lowest in the atrial septal defect group (5.6%) and highest in tetralogy of Fallot group (78.7%), being associated with complexity of diagnosis and procedure required. Blood transfusion-free open-heart surgery may be achieved in the half of the patients weighing 5-20 kg, and further miniaturization of CPB circuit and refinement of perfusion strategy might reduce transfusion rate in patients <10 kg and/or with complex congenital heart disease.

Patient Blood Management: A Patient-Orientated Approach to Blood Replacement with the Goal of Reducing Anemia, Blood Loss and the Need for Blood Transfusion in Elective Surgery

“…Additionally, modern surgical techniques such as minimal invasive surgery and the use of modern devices such as argon coagulation have led to a significant reduction of blood loss and transfusion [22]. In addition, the introduction of small-size extracorporeal circulatory devices in cardiac surgery led to a massive reduction in the use of transfusions, especially in small children and newborns [23]. The use of fibrin glue or local hemostyptics elevation of the surgical area [24], arterial embolization, use of antifibrinolytics, and short-term hypertensive provocative therapy prior to wound closure in order to identify bleeding sources can further reduce bleeding and subsequently transfusion requirements [25][26][27].…”

Effects of Mini‐Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low‐Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support

“…Lechner et al (1) and Seo et al (2) reported postoperative outcomes with the lowbodyweight neonates. Some studies have already shown clinical benefits of reduced priming volume for blood sparing and prevention of acute kidney injury (3,11,14). Many centers with considerable experience in open heart surgery for small children have established their strategy that minimizes the priming volume (1,2,(10)(11)(12)(13).…”

Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-

“…Body weight, preoperative hematocrit, priming volume of the CPB circuit, CPB time, and lowest hematocrit during CPB can predict requirements for blood transfusion during open heart surgery in small infants and neonates [12]. In our case, the patient was supplemented with erythropoietin and took oral iron prior to surgery.…”