Bloodless Priming Strategy in Cardiac Surgery with Cardiopulmonary Bypass in Lowweight Infants with Congenital Heart Disease: A Clinical Control Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZOULi-hua ¹ ,  LIUJin-ping ¹ , FENGZheng-yi ¹ , ZHAOJu ¹ , CUIYong-li ¹ , ZHAOMing-xia ¹ , LIShou-jun ² , YANJun ² , YANFu-xia ³ , WANGXu ²

1. Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, P. R. China;
2. Department of Pediatric Cardiac Surgery, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, P. R. China;
3. Department of Anesthesia, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, P. R. China;

Corresponding?author：

LIUJin-ping, Email: jinpingfw@hotmail.com

Keywords：

Cardiopulmonary bypass; Infants; Bloodless surgery

DOI：

10.7507/1007-4848.20150251

Video：

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Objective To evaluate the safety of modified blood-sparing approach in cardiac surgery with cardiopulmonary bypass (CPB) in low-weight infants (≤15 kg) with congenital heart disease. Methods A total of 283 infants were applied a new blood-sparing approach, known as without homologous blood priming, during the cardiac surgery with CPB between August 2012 and October 2013. There were 154 males and 129 females with a median (interquartile range) age of 13 (9, 20) months. The infants were assigned to an intraoperative transfusion (IT) group once having transfusion during operation. And the infants without transfusion during operation were assigned to a postoperative transfusion (PT) group or a transfusion-free (TF) group according to post-operative transfusion. All infants experienced routine heart surgery with CPB. Blood samples were collected at following time points, ie. pre-CPB, 10 minutes after CPB, before termination of CPB, and after modified ultrafiltration. Clinical data and transfusion requirements were collected and compared between three groups. Results A total of 106 infants (53 males and 53 females) completed bloodless surgery. The median (interquartile range) age was 14 (9, 22) months. A total of 121 infants (71 males and 50 females) received red blood cell (RBC) transfusion intraoperatively. The median (interquartile range) age was 10 (8, 12) months. A total of 56 infants (30 males and 26 females) at age of 15 (7, 20) months received RBC transfusion postoperatively. The intraoperative transfusion (IT) group had lower body weight (9 (7,10) kg vs. 12.6 (9,14) kg) and size (72 (68, 80) cm vs. 86 (78, 97) cm), younger age (10 (8, 12) months vs. 14 (9, 22) months), and higher 24-hour chest tube drainage volume (89 (40, 122) ml vs. 58 (30, 106) ml, P<0.05) than those in the transfusion free (TF) group. Pre-operative hematocrit was also lower in the IT group than that in the PT group and the TF group (32% (29%, 37%) vs. 39% (34%, 41%) vs. 36% (33%, 38%), P<0.05). The hospital stay in the PT group and the IT group was longer than that in the TF group, respectively (13 (8, 23) d vs. 14 (11, 22) d vs. 11(8, 20) d, P<0.05). Conclusion Although applied with blood-sparing approach, perioperative transfusion is required in some infants. Infants who are free from transfusion have shorter hospital stay and less 24-hour chest tube drainage volume. Consideration of risk factors of transfusion in this population may benefit further reduction in blood transfusion in the future.

Citation： ZOULi-hua, LIUJin-ping, FENGZheng-yi, ZHAOJu, CUIYong-li, ZHAOMing-xia, LIShou-jun, YANJun, YANFu-xia, WANGXu. Bloodless Priming Strategy in Cardiac Surgery with Cardiopulmonary Bypass in Lowweight Infants with Congenital Heart Disease: A Clinical Control Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1005-1010. doi: 10.7507/1007-4848.20150251 Copy

1.	Iyengar A1,Scipione CN,Sheth P,et al.Association of complications with blood transfusions in pediatric cardiac surgery patients.Ann Thorac Surg,2013,96(3):910-916.
2.	Salvin JW,Scheurer MA,Laussen PC,et al.Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay.Ann Thorac Surg,2011,91(1):204-210.
3.	Székely A1,Cserép Z,Sápi E,Breuer T,et al.Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations.Ann Thorac Surg,2009,87(1):187-197.
4.	Chang TT.Transfusion therapy in critically ill children.Pediatr Neonatol,2008,49(2):5-12.
5.	Vranken NP,Weerwind PW,Barenbrug PJ,et al.The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections:a retrospective study.Interact Cardiovasc Thorac Surg,2014,19(2):232-238.
6.	Rohde JM,Dimcheff DE,Blumberg N,et al.Health care-associated infection after red blood cell transfusion:a systematic review and meta-analysis.JAMA,2014,311(13):1317-1326.
7.	阜外醫院成立"無輸血心臟外科中心"——追求品質費用最優,創新手術輸血模式.中國中西醫結合雜志,2014,34(7):799.
8.	紅細胞及血漿用量.2013阜外心血管病醫院年度報告,2013.1-5.
9.	鄒麗華,劉晉萍,馮正義,等.低于15千克患兒心臟手術圍體外循環期改良節約用血策略的安全性分析.中國體外循環雜志,2015,13(2):36-41.
10.	Stover EP1,Siegel LC,Parks R,et al.Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:a 24-institution study.Institutions of the Multicenter Study of Perioperative Ischemia Research Group.Anesthesiology,1998,88(2):327-333.
11.	中國醫學科學院心血管病醫院輸血科.提高醫療質量減少手術用血.中國醫學論壇報,2011-04-14(A11).
12.	霍梅,林琳化,龔文勝,等.胎兒凝血因子活性的測定.中國實驗診斷學,2005,9(2):239-241.
13.	Silliman CC,Chaffin DJ.Broken hearts and transfusion-related acute lung injury.Crit Care Med,2012,40(10):2909-2910.
14.	Raghavan M1,Marik PE.Anemia,allogenic blood transfusion,and immunomodulation in the critically ill.Chest,2005,127(1):295-307.
15.	Agarwal HS1,Barrett SS,Barry K,et al.Association of blood products administration during cardiopulmonary bypass and excessive post-operative bleeding in pediatric cardiac surgery.Pediatr Cardiol,2015,36(3):459-467.
16.	Howard-Quijano K1,Schwarzenberger JC,Scovotti JC,et al.Increased red blood cell transfusions are associated with worsening outcomes in pediatric heart transplant patients.Anesth Analg,2013,116(6):1295-1308.
17.	Adams ES.A critical appraisal of "transfusion strategies for patients in pediatric intensive care units" by Lacroix J,Hebert PC,Hutchison,et al(N Engl J Med 2007;356:1609-1619).Pediatr Crit Care Med,2009,10(3):393-396.
18.	Whyte RK,Kirpalani H,Asztalos EV,et al.Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion.Pediatrics,2009,123(1):207-213.
19.	Kotani Y,Honjo O,Nakakura M,et al.Single center experience with a low volume priming cardiopulmonary bypass circuit for preventing blood transfusion in infants and small children.Asaio J,2009,55(3):296-299.
20.	Xydas S,Magovern CJ,Slater JP,et al.Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program.J Thorac Cardiovasc Surg,2012,143(4):926-935.
21.	Redlin M,Habazettl H,Boettcher W,et al.Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery.J Thorac Cardiovasc Surg,2012,144(2):493-499.

1. Iyengar A1,Scipione CN,Sheth P,et al.Association of complications with blood transfusions in pediatric cardiac surgery patients.Ann Thorac Surg,2013,96(3):910-916.
2. Salvin JW,Scheurer MA,Laussen PC,et al.Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay.Ann Thorac Surg,2011,91(1):204-210.
3. Székely A1,Cserép Z,Sápi E,Breuer T,et al.Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations.Ann Thorac Surg,2009,87(1):187-197.
4. Chang TT.Transfusion therapy in critically ill children.Pediatr Neonatol,2008,49(2):5-12.
5. Vranken NP,Weerwind PW,Barenbrug PJ,et al.The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections:a retrospective study.Interact Cardiovasc Thorac Surg,2014,19(2):232-238.
6. Rohde JM,Dimcheff DE,Blumberg N,et al.Health care-associated infection after red blood cell transfusion:a systematic review and meta-analysis.JAMA,2014,311(13):1317-1326.
7. 阜外醫院成立"無輸血心臟外科中心"——追求品質費用最優,創新手術輸血模式.中國中西醫結合雜志,2014,34(7):799.
8. 紅細胞及血漿用量.2013阜外心血管病醫院年度報告,2013.1-5.
9. 鄒麗華,劉晉萍,馮正義,等.低于15千克患兒心臟手術圍體外循環期改良節約用血策略的安全性分析.中國體外循環雜志,2015,13(2):36-41.
10. Stover EP1,Siegel LC,Parks R,et al.Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:a 24-institution study.Institutions of the Multicenter Study of Perioperative Ischemia Research Group.Anesthesiology,1998,88(2):327-333.
11. 中國醫學科學院心血管病醫院輸血科.提高醫療質量減少手術用血.中國醫學論壇報,2011-04-14(A11).
12. 霍梅,林琳化,龔文勝,等.胎兒凝血因子活性的測定.中國實驗診斷學,2005,9(2):239-241.
13. Silliman CC,Chaffin DJ.Broken hearts and transfusion-related acute lung injury.Crit Care Med,2012,40(10):2909-2910.
14. Raghavan M1,Marik PE.Anemia,allogenic blood transfusion,and immunomodulation in the critically ill.Chest,2005,127(1):295-307.
15. Agarwal HS1,Barrett SS,Barry K,et al.Association of blood products administration during cardiopulmonary bypass and excessive post-operative bleeding in pediatric cardiac surgery.Pediatr Cardiol,2015,36(3):459-467.
16. Howard-Quijano K1,Schwarzenberger JC,Scovotti JC,et al.Increased red blood cell transfusions are associated with worsening outcomes in pediatric heart transplant patients.Anesth Analg,2013,116(6):1295-1308.
17. Adams ES.A critical appraisal of "transfusion strategies for patients in pediatric intensive care units" by Lacroix J,Hebert PC,Hutchison,et al(N Engl J Med 2007;356:1609-1619).Pediatr Crit Care Med,2009,10(3):393-396.
18. Whyte RK,Kirpalani H,Asztalos EV,et al.Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion.Pediatrics,2009,123(1):207-213.
19. Kotani Y,Honjo O,Nakakura M,et al.Single center experience with a low volume priming cardiopulmonary bypass circuit for preventing blood transfusion in infants and small children.Asaio J,2009,55(3):296-299.
20. Xydas S,Magovern CJ,Slater JP,et al.Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program.J Thorac Cardiovasc Surg,2012,143(4):926-935.
21. Redlin M,Habazettl H,Boettcher W,et al.Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery.J Thorac Cardiovasc Surg,2012,144(2):493-499.

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Bloodless Priming Strategy in Cardiac Surgery with Cardiopulmonary Bypass in Lowweight Infants with Congenital Heart Disease: A Clinical Control Trial

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