Red blood cell storage duration is associated with various clinical outcomes in pediatric cardiac surgery.
BACKGROUND
Recommendations on the use of fresh red blood cells (RBCs) in pediatric patients undergoing cardiac surgery are based on limited information. Furthermore, the RBC storage time cut-off of fresh units remains unknown.


METHODS
Data from 139 pediatric patients who underwent cardiac surgery and received RBCs from a single unit within 14 days of storage were analyzed. To identify the optimal cut-off storage time of RBCs for transfusion, multiple multivariate analyses aimed at different outcome parameters were performed.


RESULTS
26 patients received RBC units stored for ≤3 days, while 126 patients received RBCs that were stored for 4-14 days. The latter group required more RBC transfusions and fresh frozen plasma (FFP) than the former group (19 vs. 25 ml/kg, p = 0.003 and 73% vs. 35%, p = 0.0006, respectively). In addition, the odds for the administration of FFP increased with the transfusion of RBCs stored for more than 4 days. The optimal cut-off for post-operative morbidity was observed with a storage time of ≤6 days for length of ventilation (p = 0.02) and peak of C-reactive protein (CRP; p = 0.008).


CONCLUSIONS
The obtained results indicate that the hazard of blood transfusion increased with increasing storage time of RBCs. The results of this study suggest that transfusion of fresh RBCs with a storage time of ≤2 or 4 days (concerning transfusion requirements) or ≤6 days (concerning postoperative morbidity) may be beneficial in pediatric patients undergoing cardiac surgery. However, further prospective randomized studies are required in order to draw any final conclusions.
Department of Anesthesiology, German Heart Institute, Charité University Medicine Berlin, Berlin, Germany.
Matthias
M
Redlin
Department of Anesthesiology, German Heart Institute, Charité University Medicine Berlin, Berlin, Germany ; Department of Physiology, Charité University Medicine Berlin, Berlin, Germany.
Helmut
H
Habazettl
Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany.
Helge
H
Schoenfeld
Department of Anesthesiology, German Heart Institute, Charité University Medicine Berlin, Berlin, Germany.
Marian
M
Kukucka
Department of Cardiothoracic and Vascular Surgery, German Heart Institute, Berlin, Germany.
Wolfgang
W
Boettcher
Department of Anesthesiology, German Heart Institute, Charité University Medicine Berlin, Berlin, Germany.
Hermann
H
Kuppe
Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany.
Abdulgabar
A
Salama
Blood; Clinical outcome; Erythrocytes; Inflammation; Pediatric cardiac surgery; Red blood cell storage; Transfusion