Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis.
OBJECTIVE
To determine the impact of a restrictive vs. a liberal transfusion strategy on new or progressive multiple organ dysfunction syndrome in children post cardiac surgery. The optimal transfusion threshold after cardiac surgery in children is unknown.


METHODS
Randomized, controlled trial.


METHODS
Tertiary pediatric intensive care units.


METHODS
Participants are a subgroup of pediatric patients post cardiac surgery from the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study. Exclusion criteria specific to the cardiac surgery subgroup included: age <28 days and patients remaining cyanotic.


METHODS
Critically ill children with a hemoglobin < or = 95 g/L within 7 days of pediatric intensive care unit admission were randomized to receive prestorage leukocyte-reduced red-cell transfusion if their hemoglobin dropped either <70 g/L (restrictive) or 95 g/L (liberal).


RESULTS
Postoperative cardiac patients (n = 125) from seven centers were enrolled. The restrictive (n = 63) and liberal (n = 62) groups were similar at baseline in age (mean +/- standard deviation = 31.4 +/- 38.1 mos vs. 26.4 +/- 39.1 mos), surgical procedure, severity of illness (Pediatric Risk of Mortality score = 3.4 +/- 3.2 vs. 3.2 +/- 3.2), multiple organ dysfunction syndrome (46% vs. 44%), mechanical ventilation (62% vs. 60%), and hemoglobin (83 vs. 80 g/L). Mean hemoglobin remained 21 g/L lower in the restrictive group after randomization. No significant difference was found in new or progressive multiple organ dysfunction syndrome (primary outcome) in the restrictive group vs. liberal group (12.7% vs. 6.5%; p = .36), pediatric intensive care unit length of stay (7.0 +/- 5.0 days vs. 7.4 +/- 6.4 days) or 28-day mortality (3.2% vs. 3.2%).


CONCLUSIONS
In this subgroup analysis of cardiac surgery patients, a restrictive red-cell transfusion strategy, as compared with a liberal one, was not associated with any significant difference in new or progressive multiple organ dysfunction syndrome, but this evidence is not definitive.
Pediatric Intensive Care Unit, Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.
Ariane
A
Willems
Karen
K
Harrington
Jacques
J
Lacroix
Dominique
D
Biarent
Ari R
AR
Joffe
David
D
Wensley
Thierry
T
Ducruet
Paul C
PC
Hébert
Marisa
M
Tucci
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D009102:Multiple Organ Failure / Q000517:prevention & control / Q000628:therapy; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome
D006454:Hemoglobins