The Children's Hospital of Philadelphia Philadelphia PA.
University of Iowa Stead Family Children's Hospital Iowa City IA.
J Am Heart Assoc. 2020 May 18;9(10):e015304. doi: 10.1161/JAHA.119.015304. Epub 2020 May 11.
Background Packed red blood cell transfusion may improve oxygen content in single-ventricle neonates, but its effect on clinical outcomes after Stage 1 palliation is unknown. Methods and Results Retrospective multicenter analysis of packed red blood cell transfusion exposures in neonates after Stage 1 palliation, excluding those with intraoperative mortality or need for extracorporeal membrane oxygenation. Transfusion practice variability was assessed, and multivariable regression used to identify transfusion risk factors. After propensity score adjustment for severity of illness, clinical outcomes were compared between transfused and nontransfused subjects. Of 396 subjects, 323 (82%) received 930 postoperative red blood cell transfusions. Packed red blood cell volume (median 9-42 mL/kg [<0.0001]), donor exposures (1-2 [<0.0001]), transfusion number (1-3 [<0.0001]), and pretransfusion hemoglobin (12.1-13 g/dL, =0.0049) varied between sites. Cyanosis (=0.02), chest tube output (=0.0003), and delayed sternal closure (=0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, =0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, =0.016). When stratified by number of transfusions (0, 1, or >1), duration of mechanical ventilation (3 [1, 5] versus 4 [3, 6] versus 9 [5, 16] days [<0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [<0.0001]) increased for those transfused more than once. Most subjects who died were transfused, though the association with mortality was not significant. Conclusions Packed red blood cell transfusion after Stage 1 palliation is common, and transfusion practice is variable. Transfusion is a significant predictor of longer intensive care unit stay and mechanical ventilation. Further studies to define evidence-based transfusion thresholds are warranted.
输注浓缩红细胞可提高单心室新生儿的氧含量，但它对 1 期姑息手术后的临床结局的影响尚不清楚。
对 1 期姑息手术后的新生儿进行了回顾性多中心分析，排除术中死亡或需要体外膜氧合的患者。评估了输血实践的变异性，并使用多变量回归来确定输血的危险因素。在对疾病严重程度进行倾向评分调整后，比较了输血组和非输血组的临床结局。在 396 例患者中，323 例（82%）接受了 930 次术后红细胞输血。浓缩红细胞量（中位数 9-42mL/kg [<0.0001]）、供者暴露（1-2 [<0.0001]）、输血次数（1-3 [<0.0001]）和输血前血红蛋白（12.1-13g/dL，=0.0049）在不同中心之间存在差异。发绀（=0.02）、胸腔引流管引流量（=0.0003）和延迟关胸（=0.0033）增加了输血风险。输血与机械通气时间延长（6 [四分位间距 4，12] 与 3 [1，5] 天，=0.02）和重症监护病房住院时间延长（19 [12，33] 与 9 [6，19] 天，=0.016）相关。按输血次数（0、1 或 >1）分层时，机械通气时间（3 [1，5] 与 4 [3，6] 与 9 [5，16] 天，<0.0001）和重症监护病房住院时间（9 [6，19] 与 13 [8，25] 与 21 [13，38] 天，<0.0001）随着输血次数的增加而延长。大多数死亡患者都接受了输血，但与死亡率的相关性没有统计学意义。
1 期姑息手术后输注浓缩红细胞很常见，输血实践存在差异。输血是重症监护病房住院时间和机械通气时间延长的重要预测因素。需要进一步研究以确定基于证据的输血阈值。
