Safety and Effects of Two Red Blood Cell Transfusion Strategies in Pediatric Cardiac Surgery Patients: a Randomized Controlled Trial

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2013 Sep 3

PMID 23995984

Citations 32

Authors

D H de Gast-Bakker

R B P de Wilde

M G Hazekamp

V Sojak

J J Zwaginga

R Wolterbeek

E de Jonge

B J Gesink-van der Veer

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients.

Design: Randomized controlled trial.

Setting: Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands.

Patients: One hundred seven patients with non-cyanotic congenital heart defects between 6 weeks and 6 years of age. One hundred three patients underwent corrective surgery on cardiopulmonary bypass.

Interventions: Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l).

Measurements: Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis).

Results: In the restrictive transfusion group, mean volume of transfused RBC was 186 (±70) ml per patient and in the liberal transfusion group 258 (±87) ml per patient, (95% CI 40.6-104.6), p < 0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p = 0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (±203.39) vs. 316.27 (±189.96) euros (95% CI 46.61-197.51) per patient in the restrictive transfusion group, p = 0.002.

Conclusions: For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0 g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive.

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References

Goodman A, Pollack M, Patel K, Luban N . Pediatric red blood cell transfusions increase resource use. J Pediatr. 2003; 142(2):123-7. DOI: 10.1067/mpd.2003.14. View

Hendrickson J, Hillyer C . Noninfectious serious hazards of transfusion. Anesth Analg. 2009; 108(3):759-69. DOI: 10.1213/ane.0b013e3181930a6e. View

Pollack M, Patel K, Ruttimann U . PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996; 24(5):743-52. DOI: 10.1097/00003246-199605000-00004. View

Jenkins K, Gauvreau K, Newburger J, Spray T, Moller J, Iezzoni L . Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002; 123(1):110-8. DOI: 10.1067/mtc.2002.119064. View

Hajjar L, Vincent J, Galas F, Nakamura R, Silva C, Santos M . Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010; 304(14):1559-67. DOI: 10.1001/jama.2010.1446. View

Salvin J, Scheurer M, Laussen P, Wypij D, Polito A, Bacha E . Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg. 2010; 91(1):204-10. DOI: 10.1016/j.athoracsur.2010.07.037. View

Oliver E, Carrio M, Rodriguez-Castro D, Javierre C, Farrero E, Torrado H . Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery. Intensive Care Med. 2009; 35(9):1548-55. DOI: 10.1007/s00134-009-1526-0. View

Willems A, Harrington K, Lacroix J, Biarent D, Joffe A, Wensley D . Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med. 2009; 38(2):649-56. DOI: 10.1097/CCM.0b013e3181bc816c. View

Surgenor S, Kramer R, Olmstead E, Ross C, Sellke F, Likosky D . The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009; 108(6):1741-6. DOI: 10.1213/ane.0b013e3181a2a696. View

10.

Chapman C, Stainsby D, Jones H, Love E, Massey E, Win N . Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion. 2008; 49(3):440-52. DOI: 10.1111/j.1537-2995.2008.01948.x. View

11.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

12.

Hoffman G, Mussatto K, Brosig C, Ghanayem N, Musa N, Fedderly R . Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg. 2005; 130(4):1094-100. DOI: 10.1016/j.jtcvs.2005.06.029. View

13.

Vincent J, Hajjar L . What's new in transfusion policies?. Intensive Care Med. 2013; 39(6):1002-4. DOI: 10.1007/s00134-013-2900-5. View

14.

Weiskopf R . Do we know when to transfuse red cells to treat acute anemia?. Transfusion. 1998; 38(6):517-21. DOI: 10.1046/j.1537-2995.1998.38698326330.x. View

15.

Baumgartner J, Silliman C, Moore E, Banerjee A, McCarter M . Stored red blood cell transfusion induces regulatory T cells. J Am Coll Surg. 2009; 208(1):110-9. PMC: 5787354. DOI: 10.1016/j.jamcollsurg.2008.08.012. View

16.

Marik P, Corwin H . Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008; 36(9):2667-74. DOI: 10.1097/CCM.0b013e3181844677. View

17.

Tweddell J, Hoffman G, Fedderly R, Ghanayem N, Kampine J, Berger S . Patients at risk for low systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg. 2000; 69(6):1893-9. DOI: 10.1016/s0003-4975(00)01349-7. View

18.

Tweddell J, Hoffman G . Postoperative management in patients with complex congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2002; 5:187-205. DOI: 10.1053/pcsu.2002.31499. View

19.

Kneyber M, Hersi M, Twisk J, Markhorst D, Plotz F . Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med. 2007; 33(8):1414-22. DOI: 10.1007/s00134-007-0741-9. View

20.

Tweddell J, Hoffman G, Mussatto K, Fedderly R, Berger S, Jaquiss R . Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation. 2002; 106(12 Suppl 1):I82-9. View