title: The impact of vacuum-assisted venous drainage and miniaturized bypass circuits on blood transfusion in pediatric cardiac surgery.
abstract: Although blood transfusion is essential in pediatric surgery, it is associated with increased morbidity. The goal of this study is to assess the efficiency of downsized bypass circuits and vacuum-assisted venous return in decreasing the need for blood transfusion. This study was performed on 150 patients weighing 2.3-10 kg. The bypass circuit was composed of a Kids D100 oxygenator and 3/16 in. lines, with a 120-ml prime volume. The objective was to maintain a hemoglobin level of at least 8 g/dl during the procedure. Venous drainage was both gravity-dependent and vacuum-assisted. The level and tolerance of hemodilution were estimated based on hemoglobin and serum lactate dosages and on the time to extubation. Venous drainage varied from 500 to 1200 ml/min. All patients weighing <6.4 kg were transfused and 55% of the patients weighing 6.4-10 kg had bloodless surgery, none had platelet infusion. In bloodless surgery, the median hemoglobin level was 11.4 g/dl before surgery, 8.7 g/dl during bypass, and 10.6 g/dl postoperatively, median serum lactate levels were always under 2 mmol/L and the median time to extubation was 3 hours. Compared to gravity-dependent venous drainage, vacuum-assisted venous return is efficient for further reducing allogeneic blood transfusion.
authors.affiliation: Intensive Care and Perfusion Department, Institut Hospitalier Jacques Cartier, Massy, France. iciprea@icip.org
authors.forename: Yves
authors.initials: Y
authors.lastname: Durandy
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods*; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods; D006331:Heart Diseases / Q000601:surgery; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008904:Miniaturization; D014618:Vacuum