Minimizing the need for transfusion in pediatric congenital heart surgery
International Journal of Clinical Transfusion Medicine
Blood conservation has become an essential institutional initiative in cardiac surgery patients secondary to published reports associating transfusion with increased morbidity and mortality. Cardiopulmonary bypass (CPB) for children with congenital heart disease presents unique challenges in regard to transfusion practice. The circuit size relative to the pediatric patient's circulating blood volume results in more hemodilution forcing clinicians to adopt several strategies to counteract this.
... o counteract this. It is generally agreed that the effects of hemodilution in this population are less well understood. That being said, there is evidence that neurologic outcomes are impacted by significant anemia in neonates and infants undergoing CPB. This adds to the level of concern clinicians should have when managing congenital heart surgery patients. Optimized surgical outcomes are dependent on neurologic outcomes. Specific transfusion guidelines for pediatric cardiac surgery still vary widely across institutions, and a safe minimum hematocrit on bypass has not been established. Evidence-based guidelines are more prevalent in adult cardiac surgery patients, but there are a growing number of reports for pediatrics. Clearly, well-defined operative strategies and a team approach will decrease blood product transfusions and minimize the associated risks in pediatric patients, especially in regard to neurologic outcomes. The ongoing development of evidence-based guidelines for pediatric perfusion will serve clinicians, and most importantly, their patients, well. The purpose of this review is to present current practice to limit blood transfusions in pediatric cardiac surgery exclusively inside the operating room and related to CPB as well as minimizing the side effects of the coagulation disturbances caused by the level of hemodilution these patients may encounter.