Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Clinic of Anesthesiology and Critical Care Medicine, Kepler University Clinic, Johannes Kepler University Linz, Linz, Austria.
J Cardiothorac Vasc Anesth. 2019 Dec;33(12):3249-3263. doi: 10.1053/j.jvca.2019.03.036. Epub 2019 Mar 20.
Pediatric cardiac surgery is associated with a substantial risk of bleeding, frequently requiring the administration of allogeneic blood products. Efforts to optimize preoperative hemoglobin, limit blood sampling, improve hemostasis, reduce bleeding, correct coagulopathy, and incorporate blood sparing techniques (including restrictive transfusion practices) are key elements of patient blood management (PBM) programs, and should be applied to the pediatric cardiac surgical population as across other disciplines. Many guidelines for implementation of PBM in adults undergoing cardiac surgery are available, but evidence regarding the implementation of PBM in children is limited to systematic reviews and specific guidelines for the pediatric cardiac population are missing. The objective of the task force from the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA, www.nataonline.com) is to provide evidence-based recommendations regarding anemia management and blood transfusion practices in the perioperative care of neonates and children undergoing cardiac surgery, and to highlight potential areas where additional research is urgently required.
儿科心脏手术伴随着大量出血的风险，常常需要输注异体血液制品。优化术前血红蛋白水平、限制采血、改善止血、减少出血、纠正凝血障碍以及采用血液保护技术（包括限制性输血策略）是患者血液管理（PBM）计划的关键要素，并且应该应用于儿科心脏手术患者，如同应用于其他学科。有许多关于成人心脏手术患者实施 PBM 的指南，但关于儿童患者 PBM 实施的证据仅限于系统评价，并且缺乏针对儿科心脏患者的具体指南。该工作组的目标是为新生儿和儿童心脏手术患者围手术期贫血管理和输血实践提供基于证据的推荐，并强调需要紧急开展额外研究的潜在领域。
