title: Blood conservation operations in pediatric cardiac patients: a paradigm shift of blood use.
abstract: BACKGROUND
  Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations.
  
  
  METHODS
  We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups.
  
  
  RESULTS
  Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization.
  
  
  CONCLUSIONS
  Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.
authors.affiliation: Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Georgia Health Science University, Children's Medical Center, Augusta, Georgia, USA. mohsenkarimimd@hotmail.com
authors.forename: Mohsen
authors.initials: M
authors.lastname: Karimi
authors.forename: Ivan
authors.initials: I
authors.lastname: Florentino-Pineda
authors.forename: Ted
authors.initials: T
authors.lastname: Weatherred
authors.forename: Ahsan
authors.initials: A
authors.lastname: Qadeer
authors.forename: Carol Ann
authors.initials: CA
authors.lastname: Rosenberg
authors.forename: Andrea
authors.initials: A
authors.lastname: Hudacko
authors.forename: Duchwan
authors.initials: D
authors.lastname: Ryu
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001793:Blood Preservation / Q000379:methods*; D001803:Blood Transfusion / Q000379:methods*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors