Kiskaddon Amy L, Andrews Jennifer, Josephson Cassandra D, Kuntz Michael T, Tran Dominique, Jones Jennifer, Kartha Vyas, Do Nhue L
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Institute for Clincial and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Vox Sang. 2025 Mar;120(3):293-300. doi: 10.1111/vox.13786. Epub 2024 Dec 19.
Cold-stored whole blood (CS-WB) in paediatric cardiac surgery is making a resurgence, given its identified benefits compared to conventional blood component therapy (CT).
A single-centre retrospective study was conducted from January 2018 to October 2018 by including children <18 years of age undergoing cardiac surgery requiring cardiopulmonary bypass. ABO-compatible CS-WB from non-directed random donors was leukoreduced with platelet-sparing filters and compared with CT.
Fifty-seven patients (30, 53% CS-WB; 27, 47% CT) were studied. Patient demographics were similar, although CT patients were cooled to a lower intra-operative temperature. Blood product requirements 24 h post operation were less in the CS-WB group (11.1 vs. 26.7 mL/kg, p = 0.048). Twelve (40%) patients in the CS-WB cohort had more than one donor exposure versus 25 (93%) in the CT group (p < 0.001). CT patients compared to CS-WB patients had a greater decrease in pre-operative versus 48-h post-operative haemoglobin, platelets and prothrombin time. Patients who received CT compared to CS-WB had a trend towards higher median (interquartile range [IQR]) chest-tube output (mL/kg/h) in the first 4 h post cardiac intensive care unit (ICU) admission (2.1 [0.8, 3] vs. 1.6 [0.8, 2.2], p = 0.197). There was no difference in antifibrinolytic use, length of stay, sepsis, acute kidney injury or wound infection. Survival to discharge was similar.
CS-WB in paediatric cardiac surgery may reduce donor exposure and improve haemostatic balance. Future multi-centre prospective studies are needed to validate these findings and identify patients who would benefit from CS-WB in paediatric cardiac surgery.
鉴于与传统血液成分疗法（CT）相比，已明确其具有诸多益处，冷藏全血（CS-WB）在小儿心脏手术中的应用正在再度兴起。
于2018年1月至2018年10月开展了一项单中心回顾性研究，纳入年龄小于18岁、接受需要体外循环的心脏手术的儿童。来自非定向随机供者的ABO血型相容的CS-WB使用保留血小板的滤器进行白细胞滤除，并与CT进行比较。
共研究了57例患者（30例，53%为CS-WB组；27例，47%为CT组）。患者人口统计学特征相似，尽管CT组患者术中体温降至更低水平。CS-WB组术后24小时的血液制品需求量较少（11.1 vs. 26.7 mL/kg，p = 0.048）。CS-WB队列中有12例（40%）患者接受了不止一个供者的血液，而CT组为25例（93%）（p < 0.001）。与CS-WB组患者相比，CT组患者术前至术后48小时血红蛋白、血小板和凝血酶原时间的下降幅度更大。与CS-WB组相比，接受CT治疗的患者在入住心脏重症监护病房（ICU）后的前4小时，胸腔引流管引流量中位数（四分位数间距[IQR]）有升高趋势（mL/kg/h）（2.1 [0.8, 3] vs. 1.6 [0.8, 2.2]，p = 0.197）。抗纤溶药物使用、住院时间、败血症、急性肾损伤或伤口感染方面无差异。出院生存率相似。
小儿心脏手术中使用CS-WB可能会减少供者暴露并改善止血平衡。未来需要开展多中心前瞻性研究来验证这些发现，并确定哪些小儿心脏手术患者将从CS-WB中获益。
