Blood transfusion in pediatric cardiac surgery.
The aim of the study is to measure the volume of homologous blood needed for one pediatric patient during his hospital stay. Over a 4-month period, all the patients operated upon with a blood prime or requiring blood transfusion during their hospital stay were included in this study.The cardiopulmonary bypass protocol associates a miniaturized bypass circuit, vacuum-assisted venous drainage, and microplegia. The volume of each blood product opened is known and the volume of blood product remaining, following the last transfusion, is measured. Data collected areas follows: patient weight; hemoglobin level before surgery,during bypass, and in intensive care after the last transfusion;time to extubation; and degree of inotropic support.Forty-six patients weighing 5.1 1.5 kg were included in this study. Cardiopulmonary bypass priming volume was 100 mL for patients up to 3.5 kg, 120 mL for patients between 3.6 and 7.5 kg, and 160 mL for patients between 7.6 and 8.6 kg. The volume of blood transfusion was 271 112 mL, hemoglobin level before surgery was 10.3 1.7 g/dL, hemoglobin level during surgery was 11.0 1.5 g/dL, and hemoglobin level after the last transfusion was 12.3 2.4 g/dL. Time to extubation was 12 3.3 h, and inotropic support was enoximone in 37 patients,whereas 6 patients needed enoximone and epinephrine.No patient needed reexploration for bleeding and one patient received a platelet transfusion.The mean blood transfusion volume was equivalent to 60% of the patient’s total blood volume (estimated to be 80 mL/kg).
Intensive Care Unit and Perfusion Department,Pediatric Cardiac Surgery, Institut HospitalierJacques Cartier, Massy, France. iciprea@icip.org
Yves
Y
Durandy
D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D001810:Blood Volume; D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004867:Equipment Design; D005602:France; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008904:Miniaturization; D017713:Platelet Transfusion; D012121:Respiration, Artificial; D013997:Time Factors
D015415:Biomarkers; D002316:Cardiotonic Agents; D006454:Hemoglobins