Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants.
BACKGROUND
In an attempt to reduce the coagulopathic and inflammatory responses seen after cardiopulmonary bypass, the use of fresh whole blood during heart operations has become the standard of care for neonates and infants at many institutions. We compared the use of fresh whole blood with the use of a combination of packed red cells and fresh-frozen plasma (reconstituted blood) for priming of the cardiopulmonary bypass circuit.


METHODS
We conducted a single-center, randomized, double-blind, controlled trial involving children less than one year of age who underwent open-heart surgery. Patients were assigned to receive either fresh whole blood that had been collected not more than 48 hours previously (96 patients) or reconstituted blood (104 patients) for bypass-circuit priming. Clinical outcomes and serologic measures of systemic inflammation and myocardial injury were compared between the groups.


RESULTS
The group that received reconstituted blood had a shorter stay in the intensive care unit than the group that received fresh whole blood (70.5 hours vs. 97.0 hours, P=0.04). The group that received reconstituted blood also had a smaller cumulative fluid balance at 48 hours (-6.9 ml per kilogram of body weight vs. 28.8 ml per kilogram, P=0.003). Early postoperative chest-tube output, blood-product transfusion requirements, and levels of serum mediators of inflammation and cardiac troponin I were similar in the two groups.


CONCLUSIONS
The use of fresh whole blood for cardiopulmonary bypass priming has no advantage over the use of a combination of packed red cells and fresh-frozen plasma during surgery for congenital heart disease. Moreover, circuit priming with fresh whole blood is associated with an increased length of stay in the intensive care unit and increased perioperative fluid overload.
Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas 75235, USA.
Steven S
SS
Mou
Brett P
BP
Giroir
Erica A
EA
Molitor-Kirsch
Steven R
SR
Leonard
Hisashi
H
Nikaidoh
Frank
F
Nizzi
Deborah A
DA
Town
Lonnie C
LC
Roy
William
W
Scott
Daniel
D
Stromberg
D000209:Acute-Phase Proteins; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002352:Carrier Proteins / Q000097:blood; D003176:Complement C3 / Q000032:analysis; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D015850:Interleukin-6 / Q000097:blood; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D010949:Plasma; D011183:Postoperative Complications; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002352:Carrier Proteins; D003176:Complement C3; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D019210:Troponin I; D000099231:Lipopolysaccharide-Binding Protein