Effect of Prime Blood Storage Duration on Clinical Outcome After Pediatric Cardiac Surgery.
BACKGROUND
In this study, we tested the hypothesis that in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) with blood prime, the storage duration of the packed red blood cells (PRBCs) used in prime led to differences in postoperative complications and metabolic profiles of the patients.


METHODS
For this prospective observational study we included 400 pediatric patients undergoing cardiac operations using CPB and requiring PRBCs prime. To study the effect of storage duration of PRBCs on postoperative morbidity, mortality, and metabolic profile, patients were divided into four groups (based on storage duration of PRBCs used in prime). Group 1: ≤7 days, group 2: 8 to 14 days, group 3: 15 to 21 days, and group 4: >21 days.


RESULTS
On univariate analysis, patients transfused with PRBCs stored >14 days had significantly higher incidence of postoperative complications, for example, liver dysfunction, hematological complications, sepsis, and multiorgan failure. However, after regression analysis and adjusting for the other confounder's effects, no significant association was found between storage duration of PRBCs and postoperative complications and mortality. Metabolic profile of PRBCs was observed to become deranged with increasing duration of storage. This, however, improved to near physiological range early after the initiation of CPB and remained normal one hour after weaning from CPB, irrespective of the storage duration.


CONCLUSIONS
Storage duration of PRBCs used for priming the pediatric CPB circuit neither affects the metabolic profile of the patients on CPB or early after surgery, nor it has any association with postoperative complications and mortality.
1 Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Arvind Kumar
AK
Bishnoi
1 Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Pankaj
P
Garg
1 Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Kartik
K
Patel
1 Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Parth
P
Solanki
2 Department of Pediatric Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Jigar
J
Surti
3 Department of Perfusion, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Atul
A
Solanki
4 Department of Research, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Komal
K
Shah
4 Department of Research, UN Mehta Institute of Cardiology and Research Center, BJ Medical College, New Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Sanjay
S
Patel
D001793:Blood Preservation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors
cardiopulmonary bypass; metabolite.; pediatrics; prime; red blood cells