title: The effect of cardiopulmonary bypass prime volume on the need for blood transfusion after pediatric cardiac surgery.
abstract: OBJECTIVE
  There is increasing awareness that erythrocyte transfusions after pediatric cardiac surgery have deleterious effects. Despite reports of decreased transfusion requirements associated with smaller cardiopulmonary bypass circuits, the relationship between circuit prime volume and need for transfusion has not been systematically examined.
  
  
  METHODS
  Pediatric patients at our institution who underwent cardiopulmonary bypass between January 2005 and December 2010 were reviewed. Demographics, intraoperative data, and transfusion of packed red blood cells were retrospectively recorded. Cardiopulmonary bypass prime volume was indexed by patient body surface area. Logistic regression analysis was used to correlate these variables with need for transfusion.
  
  
  RESULTS
  In the perioperative period, 1912 patients received transfusions and 266 did not. In univariate analysis, indexed prime volume was a significant predictor of transfusion (odds ratio, 1.007; P < .001). Other significant variables in univariate analysis included age, surgeon, Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) category, preoperative hemoglobin, total bypass time, aortic crossclamp time, use and duration of deep hypothermic circulatory arrest, lowest body core temperature, and cardiopulmonary bypass flow rate. Previous cardiac surgery was not a significant predictor. In multivariable analysis controlling for RACHS-1 category, surgeon, minimal core body temperature, and preoperative hemoglobin, indexed prime volume remained an independent predictor of transfusion (odds ratio, 1.006; 95% confidence interval, 1.005-1.007, P < .001).
  
  
  CONCLUSIONS
  Perioperative need for transfusion in pediatric cardiac surgical patients is independently related to the prime volume of the cardiopulmonary bypass circuit. It therefore seems prudent to minimize circuit prime volumes to avoid unnecessary use of blood products.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: mr2306@columbia.edu.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Kevin
authors.initials: K
authors.lastname: Charette
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies