Wilhelm Michael, Torgeson Jenna, Cook Connor, Erdmann Alexandra, Boriosi Juan, Lamers Luke
Division of Pediatric Critical Care, Department of Pediatrics, University of Wisconsin-Madison, Madison, USA.
Division of Cardiology, Department of Pediatrics, University of Wisconsin-Madison, Madison, USA.
Pediatr Cardiol. 2025 Jun;46(5):1320-1327. doi: 10.1007/s00246-024-03553-2. Epub 2024 Jun 25.
The objective of this study is to describe interventions and outcomes of a quality improvement (QI) project to reduce red blood cell transfusion (RBCT) within 72 h of pediatric cardiac catheterization. Using Plan-Do-Study-Act (PDSA) methodology, we applied interventions including (1). Intraprocedural-to reduce hemodilution, blood loss, and excessive anticoagulation, (2). Standardization of institutional transfusion criteria, and (3). "Hard stop" requiring QI team consultation prior to elective post-catheterization RBCT. Primary outcome measures were frequency of RBCT from IMPACT quarterly reports and cases between transfusions (CBT). Length of stay (LOS) was the primary countermeasure. Characteristics of patients who did and did not receive RBCT were compared. 698 pediatric cardiac catheterizations occurred between 4/2017 and 8/2023. Intraprocedural interventions did not alter frequency of RBCT or CBT. Standardized transfusion guidelines followed by the "hard stop" decreased RBCT frequency from 10 to 1.9% and increased CBT without increasing LOS. Patients requiring RBCT were younger (medians 0.31 vs 2.4 years), smaller (5.2 vs 11.8 kg), and had longer procedures (2.24 vs 1.57 h) all p < 0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%; RR = 4.57, 95% CI 2.29-10.4; p < 0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups. Programmatic adherence to standardized peri-procedural transfusion guidelines successfully decreased RBCT without compromising patient care or increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were all associated with RBCT risk.
本研究的目的是描述一项质量改进（QI）项目的干预措施和结果，该项目旨在减少小儿心脏导管插入术后72小时内的红细胞输注（RBCT）。我们采用计划-实施-研究-改进（PDSA）方法，应用了以下干预措施：（1）术中——减少血液稀释、失血和过度抗凝；（2）规范机构输血标准；（3）“硬停止”措施，即在选择性导管插入术后RBCT前需QI团队会诊。主要结局指标为IMPACT季度报告中的RBCT频率和两次输血之间的病例数（CBT）。住院时间（LOS）是主要的应对指标。比较了接受和未接受RBCT的患者特征。2017年4月至2023年8月期间共进行了698例小儿心脏导管插入术。术中干预未改变RBCT频率或CBT。遵循“硬停止”措施的标准化输血指南使RBCT频率从10%降至1.9%，并增加了CBT，同时未增加LOS。需要RBCT的患者更年幼（中位数分别为0.31岁和2.4岁）、体重更轻（5.体重2kg和11.8kg）、手术时间更长（2.24小时和1.57小时），所有p值均<0.001。单心室患者比单纯双心室患者更有可能接受RBCT（14.1%比3.1%；RR = 4.57，95% CI 2.29 - 10.4；p < 0.001）。两组之间的手术类型（诊断性与干预性）和起始血红蛋白浓度具有可比性。在不影响患者护理或增加LOS的情况下，按计划坚持标准化的围手术期输血指南成功降低了RBCT。年龄较小、体重较低、手术时间和单心室生理状态均与RBCT风险相关。
