title: A single-center strategy to minimize blood transfusion in neonates and children undergoing cardiac surgery.
abstract: BACKGROUND
  The transfusion of blood products in the setting of uncontrolled bleeding is unquestionably lifesaving. However, in many instances, the decision to transfuse is based on physician gestalt rather than medical evidence. When indications for transfusion are unclear, the benefits of blood products must be balanced against their significant risks and associated costs. As our institution is a referral center for patients of Jehovah's Witness faith, this population has pushed our development of techniques to achieve the goal of bloodless surgery. Our practices in caring for this population have become our standard practice for managing all patients undergoing congenital cardiac surgery.
  
  
  OBJECTIVE
  To evaluate our success in minimizing the use of blood products during pediatric cardiac surgery.
  
  
  METHODS
  After IRB approval, we retrospectively reviewed all patients who underwent cardiac surgery utilizing cardiopulmonary bypass (CPB), for biventricular repair procedures. The study was conducted at a single institution (Nationwide Children's Hospital (NCH)) during the period: January 1, 2013 and December 31, 2013.
  
  
  RESULTS
  A total of 209 patients were included. Overall, 81 patients (38.8%) and 81 of 136 (59.6%) weighing more than 6 kg received no blood products (bloodless) during their entire hospital stay. Bloodless surgery was most successful in patients weighing more than 18 kg, followed by patients weighing 6-18 kg. All 73 patients who weighed <6 kg received blood transfusion during their hospitalization.
  
  
  CONCLUSIONS
  The techniques that we have developed to initially care for our Jehovah's Witness families may be applied to other pediatric and adult surgical procedures.
authors.affiliation: Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Aymen N
authors.initials: AN
authors.lastname: Naguib
authors.forename: Peter D
authors.initials: PD
authors.lastname: Winch
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.forename: Janet
authors.initials: J
authors.lastname: Simsic
authors.forename: Diane
authors.initials: D
authors.lastname: Hersey
authors.forename: Kathleen
authors.initials: K
authors.lastname: Nicol
authors.forename: Thomas
authors.initials: T
authors.lastname: Preston
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.forename: Patrick
authors.initials: P
authors.lastname: McConnell
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033221:Jehovah's Witnesses; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012068:Religion and Medicine; D012189:Retrospective Studies; D055815:Young Adult
keywords: adverse; blood transfusion - hematology; congenital heart disease - cardiac; events - complications; infant - age; neonate - age