Sebastian Roby, Ahmed M Iqbal
Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Children's Medical Center, Dallas, TX, United States.
Front Cardiovasc Med. 2021 Aug 19;8:689623. doi: 10.3389/fcvm.2021.689623. eCollection 2021.
Pediatric cardiac surgery is associated with significant perioperative blood loss needing blood product transfusion. Transfusion carries serious risks and implications on clinical outcomes in this vulnerable population. The need for transfusion is higher in children and is attributed to several factors including immaturity of the hemostatic system, hemodilution from the CPB circuit, excessive activation of the hemostatic system, and preoperative anticoagulant drugs. Other patient characteristics such as smaller relative size of the patient, higher metabolic and oxygen requirements make successful blood transfusion management extremely challenging in this population and require meticulous planning and multidisciplinary teamwork. In this narrative review we aim to summarize risks and complications associated with blood transfusion in pediatric cardiac surgery and also to summarize perioperative coagulation management and blood conservation strategies.
小儿心脏手术伴随着大量的围手术期失血，需要输血治疗。输血对这一脆弱群体的临床结局具有严重风险和影响。儿童输血需求更高，这归因于多种因素，包括止血系统不成熟、体外循环回路导致的血液稀释、止血系统过度激活以及术前抗凝药物。其他患者特征，如患者相对体型较小、代谢和氧气需求较高，使得在这一群体中成功进行输血管理极具挑战性，需要精心规划和多学科团队协作。在这篇叙述性综述中，我们旨在总结小儿心脏手术中与输血相关的风险和并发症，同时总结围手术期凝血管理和血液保护策略。
