Whole Blood in Pediatric Craniofacial Reconstruction Surgery

Thottathil, Princy; Sesok‐Pizzini, Deborah; Taylor, Jesse A.; Fiadjoe, John E.; Vincent, Ariel; Stricker, Paul A.

doi:10.1097/scs.0000000000003594

Cited by 17 publications

(17 citation statements)

References 18 publications

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“…This conflicts with the results of a prior retrospective study conducted at our institution of 111 patients who received either whole blood or donor-matched reconstituted blood (consisting of pRBCs and FFP from the same blood donor) due to an institutional practice change. 5 It is possible that our study was insufficiently powered to detect a difference in the number of blood donor exposures or that surgical technique modifications over the time period contributed to the findings from the prior study.…”

Section: Discussionmentioning

confidence: 90%

“…(pRBCs), 4 the use of whole blood in place of blood component therapy, 5 use of pRBCs and fibrinogen concentrate, 6,7 or prophylactic fibrinogen infusion. 8 One potential strategy to evaluate current blood management strategies is viscoelastic testing with the thromboelastography (TEG) assay (TEG, Haemonetics, Boston, MA), or the rotational thromboelastography (ROTEM) assay.…”

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confidence: 99%

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Thromboelastography Changes of Whole Blood Compared to Blood Component Transfusion in Infant Craniosynostosis Surgery

Nelson

Swanson

et al. 2021

Journal of Craniofacial Surgery

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Surgical treatment of craniosynostosis with cranial vault reconstruction in infants is associated with significant blood loss. The optimal blood management approach is an area of active investigation. Thromboelastography (TEG) was used to examine changes in coagulation after surgical blood loss that was managed by transfusion with either whole blood or blood components. Transfusion type was determined by availability of whole blood from the blood bank.This retrospective study examined differences in posttransfusion TEG maximum amplitude (MA), a measure of the maximum clot strength, for patients transfused with whole blood or blood components. We included all patients less than 24 months old who underwent cranial vault remodeling, received intraoperative transfusions with whole blood or blood components, and had baseline and posttransfusion TEG measured. Whole blood was requested for all patients and was preferentially used when it was available from the American Red Cross.Of 48 eligible patients, 30 received whole blood and 18 received blood components. All patients received an intraoperative antifibrinolytic agent. The posttransfusion MA in the whole blood group was 61.8 mm (IQR 59.1, 64.1) compared to 57.9 mm (IQR 50.5, 60.9) in the blood components group (P ¼ 0.010). There was a greater posttransfusion decrease in MA for patients transfused with blood components (median decrease of 7.7 mm [IQR À3.4, 6.3]) compared with whole blood (median decrease of 2.1 mm [IQR À9.6, 7.5] P < 0.001).Transfusion with blood components was associated with a greater decrease in MA that was likely related to decreased postoperative fibrinogen in this group. Patients who received whole blood had higher postoperative fibrinogen levels.

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

Thromboelastography Changes of Whole Blood Compared to Blood Component Transfusion in Infant Craniosynostosis Surgery

Nelson

Swanson

et al. 2021

Journal of Craniofacial Surgery

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“…In 2014, the US Tactical Combat Casualty Care Committee recommended whole blood as the optimal product for resuscitation in combat casualty care of massive hemorrhage . Low‐titer group O whole blood has had promising use in civilians also, including use in children with massive hemorrhage or during craniofacial or other surgeries where blood loss is significant …”

Section: Discussionmentioning

confidence: 99%

Evaluating emergency‐release blood transfusion of newborn infants at the Intermountain Healthcare hospitals

et al. 2019

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BACKGROUND: An emergency-release blood transfusion (ERBT) protocol (uncrossmatched type O-negative red blood cells, AB plasma, AB platelets) is critical for neonatology practice. However, few reports of emergency transfusions are available. We conducted an ERBT quality improvement project as a basis for progress. STUDY DESIGN AND METHODS:For each ERBT in the past 8 years, we logged indications, products, locations and timing of the transfusions, and outcomes. ABBREVIATIONS: CPDA-1 = citrate phosphate dextrose adenine 1; ERBT = emergency-release blood transfusion; IRB = Institutional Review Board; NICU = neonatal intensive care unit; QI = quality improvement; REDCap = Research Electronic Data Capture. From the ERBT = emergency-release blood transfusion; IVH = intraventricular hemorrhage; UAC = umbilical artery catheter; UVC = umbilical venous catheter.

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“…The strengths of this QI initiative include the large number of patients, a long duration of follow-up, the discrete interventions, and a systematic prospective data capture. Although we have previously described the outcomes of these interventions, 1,3,[5][6][7][8][9][10][11] the authors of those studies did not report on our "real world" experience of caring for this population because they excluded patients who were not receiving the designated interventions. The data we have presented provide insight into the summative effect of these sequential improvement efforts.…”

Section: Limitationsmentioning

confidence: 99%

“…We have demonstrated that monitoring central venous pressure is not an accurate measure of volume status in CCVR surgery, 6 that reconstituted blood 7 and antifibrinolytics 3 can reduce blood loss and donor exposures, that the use of postoperative transfusion guidelines can lead to a more rational postoperative transfusion practice, 8 and that whole blood provides some unique advantages in terms of limiting the incidence of perioperative coagulopathy in patients who are undergoing CCVR. 9 All of these studies were conducted as retrospective case-control studies with specific inclusion and exclusion criteria. However, we have not analyzed the summative effects of our interventions over time in our entire craniofacial population nor have we evaluated the impact of these interventions on total perioperative blood transfusion rates.…”

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confidence: 99%

Care Standardization Reduces Blood Donor Exposures and Transfusion in Complex Cranial Vault Reconstruction

Muhly¹,

Tan²,

Hsu³

et al. 2018

Hospital Pediatrics

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BACKGROUND: Complex cranial vault reconstruction (CCVR) often requires a large-volume transfusion of blood products. We implemented a series of improvement interventions to reduce blood donor exposures (BDE) and transfusion requirements in CCVR. METHODS: We implemented interventions over 4 epochs: (E1) reconstituted blood (1:1 ratio of donormatched red blood cells and fresh-frozen plasma) for intraoperative transfusions, (E2) reconstituted blood plus postoperative transfusion guidelines, (E3) reconstituted blood plus intraoperative antifibrinolytics and postoperative guidelines, and (E4) fresh whole blood for intraoperative transfusion, antifibrinolytics, and postoperative guidelines. Primary outcomes, BDE, and total volume of blood products transfused are presented by using statistical process control charts, with statistical comparisons between each epoch and baseline data. RESULTS: We included 347 patients ,72 months old who underwent CCVR between 2008 and 2016 (E1: n 5 50; E2: n 5 41; E3: n 5 87; and E4: n 5 169). They were compared with a baseline sample group of 138 patients who were managed between 2001 and 2006. Compared with our baseline group, patients in each epoch had a significant reduction in BDE (P 5 .02-,.0001). Conversely, compared with the baseline group, we observed an increase the volume of blood products transfused in E1 (P 5 .004), no difference in E2 (P 5 .6) or E3 (P 5 .46), and a reduction in the volume of blood products transfused in E4 (P , .0001). CONCLUSIONS: The implementation of sequential clinical improvement strategies resulted in a sustained reduction in BDE whereas only the use of whole blood resulted in a significant reduction in the total volume of blood products transfused in children undergoing CCVR.

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Whole Blood in Pediatric Craniofacial Reconstruction Surgery

Abstract: There was no postoperative coagulopathy in the WB cohort. Whole blood was also associated with significantly fewer perioperative BDEs. Whole blood appears to be as effective as RB for replacement of blood loss in craniofacial surgery.

Cited by 17 publications

References 18 publications

Thromboelastography Changes of Whole Blood Compared to Blood Component Transfusion in Infant Craniosynostosis Surgery

Thromboelastography Changes of Whole Blood Compared to Blood Component Transfusion in Infant Craniosynostosis Surgery

Evaluating emergency‐release blood transfusion of newborn infants at the Intermountain Healthcare hospitals

Care Standardization Reduces Blood Donor Exposures and Transfusion in Complex Cranial Vault Reconstruction

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