Kato Hideyuki, Chasovskyi Kyrylo, Gandhi Sanjiv K
Division of Cardiovascular and Thoracic Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada.
Division of Cardiovascular and Thoracic Surgery, Perfusion Services, BC Children's Hospital, 4480 Oak Street, Suite AB307, Vancouver, BC, V6H 3V4, Canada.
Pediatr Cardiol. 2020 Jun;41(5):932-938. doi: 10.1007/s00246-020-02338-7. Epub 2020 Mar 13.
A restrictive blood transfusion strategy has emerged in adult cardiac surgery. However, the feasibility in children is poorly investigated. 352 consecutive patients undergoing open-heart surgery were retrospectively reviewed, excluding patients requiring extracorporeal membrane oxygenation. Patient demographics, perioperative blood product usage, and clinical outcome parameters were investigated. Variables predicting the need for blood products were delineated. Of the 352 study patients, 148 patients (42%) underwent bloodless surgery and 204 (58%) were transfused. Of the 204 transfused patients, 170 (83.4%) patients received one blood transfusion and 34 (16.6%) received two or more blood transfusions. Patient's weight and preoperative hematocrit (Hct) were statistically significant in predicting the need for blood priming the CPB circuit (AUC 0.99, p < 0.001, sensitivity 96.6%, specificity 95.2%). A body weight of 8.5 kg carried a sensitivity of 100% and specificity of 94.5% (p < 0.001) for a blood prime. Among patients with a weight less than 8.5 kg (n = 171), only 27 patients (15.8%, p < 0.001) required additional transfusion of PRBCs. Factors impacting the need for a blood transfusion during CPB included redo surgery [odds ratio (OR) 4.61, p = 0.001] and the highest lactate level on CPB (OR 1.65, p = 0.006). Redo surgery had the highest impact (OR 7.27, p = 0.012) for requiring a postoperative PRBC transfusion. A restrictive transfusion strategy can be safely implemented in pediatric cardiac surgery. The majority of children with a BW > 8.5 kg required no blood products and those with a BW ≤ 8.5 kg required only 1 unit of blood, to prime the cardiopulmonary bypass circuit.
一种限制性输血策略已在成人心脏手术中出现。然而，其在儿童中的可行性研究较少。对352例连续接受心脏直视手术的患者进行回顾性分析，排除需要体外膜肺氧合的患者。研究患者的人口统计学特征、围手术期血液制品使用情况及临床结局参数。确定预测血液制品需求的变量。在352例研究患者中，148例（42%）接受了无血手术，204例（58%）接受了输血。在204例输血患者中，170例（83.4%）接受了一次输血，34例（16.6%）接受了两次或更多次输血。患者体重和术前血细胞比容（Hct）在预测体外循环（CPB）回路预充血液需求方面具有统计学意义（曲线下面积0.99，p<0.001，敏感性96.6%，特异性95.2%）。体重8.5kg对预充血液的敏感性为100%，特异性为94.5%（p<0.001）。在体重小于8.5kg的患者（n=171）中，仅27例（15.8%，p<0.001）需要额外输注红细胞悬液（PRBCs）。影响CPB期间输血需求的因素包括再次手术[比值比（OR）4.61，p=0.001]和CPB期间最高乳酸水平（OR 1.65，p=0.006）。再次手术对术后PRBC输血需求的影响最大（OR 7.27，p=0.012）。限制性输血策略可在小儿心脏手术中安全实施。大多数体重>8.5kg的儿童不需要血液制品，而体重≤8.5kg的儿童仅需要1单位血液用于预充心肺旁路回路。
