title: Longer blood storage is associated with suboptimal outcomes in high-risk pediatric cardiac surgery.
abstract: BACKGROUND
  The negative effects of long-term storage of allogeneic red blood cells (RBCs) on outcomes in adult cardiac surgery have been established, but evidence of a similar effect in pediatric cardiac surgery is limited.
  
  
  METHODS
  The weighted average duration of storage for RBC units used in 1,225 pediatric cardiac operations was determined. Operations were divided into high RBC use (more than 4 units or more than 150 mL/kg) or low RBC use. For both categories, associations between storage duration and surgical outcomes, adjusted for relevant patient characteristics, were evaluated.
  
  
  RESULTS
  High RBC use was associated with higher surgical complexity. Storage duration for patients who received low RBC volumes was not associated with surgical outcomes. For patients with high RBC transfusion volumes, longer storage duration (per day) was associated with higher odds of bleeding complications (odds ratio 1.029, p=0.07), renal insufficiency (odds ratio 1.085, p=0.001), higher inotrope score after surgery (12 to 24 hours +0.08, p=0.002; 24 to 48 hours +0.07, p<0.001), greater chest tube drainage (24 hours +1.5 mL/kg, p<0.001), longer postoperative hospitalization (+0.3 days p=0.02), and increased in-hospital mortality (odds ratio 1.054, p=0.03). Effects of RBC transfusions on postoperative bleeding were greatest for storage duration longer than 14 days.
  
  
  CONCLUSIONS
  The freshest RBC units available should be used for pediatric cardiac operations expected to require more than 4 units or more than 150 mL/kg of allogeneic RBC transfusions, with no units more than 14 days old being transfused whenever possible.
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Ines B
authors.initials: IB
authors.lastname: Menjak
authors.forename: Hyeamin
authors.initials: H
authors.lastname: Yoon
authors.forename: Helen M
authors.initials: HM
authors.lastname: Holtby
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Chan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.forename: Lynn
authors.initials: L
authors.lastname: Crawford-Lean
authors.forename: Celeste
authors.initials: C
authors.lastname: Foreman
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Gruenwald
mesh_terms: D000293:Adolescent; D001793:Blood Preservation / Q000009:adverse effects* / Q000379:methods; D058731:Blood Safety; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D004906:Erythrocyte Count; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome