Blood conservation operations in pediatric cardiac patients: A paradigm shift of blood use

Mohsen Karimi, Ivan Florentino, Ted W Weatherred, Ahsan Qadeer, Carol Ann Rosenberg, Andrea Hudacko, Duchwan Ryu

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. Methods: We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups. Results: Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization. Conclusions: Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.

Original languageEnglish (US)
Pages (from-to)962-967
Number of pages6
JournalAnnals of Thoracic Surgery
Volume95
Issue number3
DOIs
StatePublished - Mar 1 2013

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Mechanical Ventilators
Pediatrics
Blood Transfusion
Hemoglobins
Blood Group Antigens
Erythrocyte Transfusion
Length of Stay
Cardiopulmonary Bypass
Weights and Measures
Hospitalization
Logistic Models
Regression Analysis
Databases
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Blood conservation operations in pediatric cardiac patients : A paradigm shift of blood use. / Karimi, Mohsen; Florentino, Ivan; Weatherred, Ted W; Qadeer, Ahsan; Rosenberg, Carol Ann; Hudacko, Andrea; Ryu, Duchwan.

In: Annals of Thoracic Surgery, Vol. 95, No. 3, 01.03.2013, p. 962-967.

Research output: Contribution to journalArticle

Karimi, Mohsen ; Florentino, Ivan ; Weatherred, Ted W ; Qadeer, Ahsan ; Rosenberg, Carol Ann ; Hudacko, Andrea ; Ryu, Duchwan. / Blood conservation operations in pediatric cardiac patients : A paradigm shift of blood use. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 3. pp. 962-967.
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abstract = "Background: Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. Methods: We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups. Results: Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization. Conclusions: Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.",
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T2 - A paradigm shift of blood use

AU - Karimi, Mohsen

AU - Florentino, Ivan

AU - Weatherred, Ted W

AU - Qadeer, Ahsan

AU - Rosenberg, Carol Ann

AU - Hudacko, Andrea

AU - Ryu, Duchwan

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N2 - Background: Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. Methods: We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups. Results: Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization. Conclusions: Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.

AB - Background: Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. Methods: We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups. Results: Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization. Conclusions: Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.

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