title: Duration of red blood cell storage and outcomes in pediatric cardiac surgery: an association found for pump prime blood.
abstract: BACKGROUND
  Cardiac surgery using cardiopulmonary bypass in newborns, infants and small children often requires intraoperative red blood cell transfusions to prime the circuit and oxygenator and to replace blood lost during surgery. The purpose of this study was to investigate the influence of red blood cell storage time prior to transfusion on postoperative morbidity in pediatric cardiac operations.
  
  
  METHODS
  One hundred ninety-two consecutive children aged five years or less who underwent cardiac operations using cardiopulmonary bypass and who received red blood cells for priming the cardiopulmonary bypass circuit comprised the blood-prime group. Forty-seven patients receiving red blood cell transfusions after cardiopulmonary bypass were separately analyzed. Patients in the blood-prime group were divided into two groups based on the duration of storage of the red blood cells they received. The newer blood group included patients who received only red blood cells stored for less than or equal to four days and the older blood group included patients who received red blood cells stored for more than four days.
  
  
  RESULTS
  Patients in the newer blood group had a significantly lower rate of pulmonary complications (3.5% versus 14.4%; P = 0.011) as well as a lower rate of acute renal failure (0.8% versus 5.2%; P = 0.154) than patients in the older blood group. Major complications (calculated as a composite score based on pulmonary, neurological, and gastroenterological complications, sepsis and acute renal failure) were found in 6.9% of the patients receiving newer blood and 17.1% of the patients receiving older blood (P = 0.027). After adjusting for other possible confounding variables, red blood cell storage time remained an independent predictor of major morbidity. The same association was not found for patients receiving red blood cell transfusions after cardiopulmonary bypass.
  
  
  CONCLUSIONS
  The storage time of the red blood cells used for priming the cardiopulmonary bypass circuit in cardiac operations on newborns and young infants is an independent risk factor for major postoperative morbidity. Pulmonary complications, acute renal failure, and infections are the main complications associated with increased red blood cell storage time.
authors.affiliation: Department of Cardiothoracic-vascular Anesthesia and Intensive Care, IRCCS Policlinico S, Donato, San Donato Milanese, Milan, 20097, Italy. cardioanestesia@virgilio.it
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.forename: Concetta
authors.initials: C
authors.lastname: Carlucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.forename: Alessandra
authors.initials: A
authors.lastname: Boncilli
authors.forename: Donatella
authors.initials: D
authors.lastname: De Benedetti
authors.forename: Teresa
authors.initials: T
authors.lastname: De la Torre
authors.forename: Simonetta
authors.initials: S
authors.lastname: Brozzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
mesh_terms: D001793:Blood Preservation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D004905:Erythrocyte Aging / Q000502:physiology*; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn / Q000097:blood; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome