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J Thorac Cardiovasc Surg 2004;127:953-958
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery

^a Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Japan

Received for publication April 1, 2003; revisions received June 3, 2003; revisions received June 19, 2003; accepted for publication July 10, 2003.

^* Address for reprints: Yoshio Ootaki, MD, Department of Cardiothoracic Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, Hyogo 654-0081, Japan
y.ootaki{at}nifty.ne.jp

OBJECTIVES: Low-hematocrit bypass is one technique used to prevent allogeneic transfusion during cardiopulmonary bypass. The purpose of this study is to determine the efficacy of a criterion-driven transfusion protocol and the effect of low-hematocrit bypass with moderate hypothermia in pediatric cardiac surgery.

METHODS: Seventy-five children who underwent cardiopulmonary bypass with low-hematocrit bypass for repair of congenital heart disease were studied. Criteria for red blood cell transfusion included anemia with a hematocrit level of less than 15% during bypass and 20% after bypass. During cardiopulmonary bypass, venous oxygen saturation, hematocrit values, and regional cerebral oxygenation were continuously monitored. Arterial lactate levels were measured postoperatively.

RESULTS: All patients had an uncomplicated perioperative course, and no perioperative death occurred. Twenty-two patients (29.3%) received a transfusion, and 53 (70.7%) patients did not. The hematocrit levels before and after modified ultrafiltration in the transfused group (21.6 ± 5.5%, 26.6 ± 6.5%) were significantly higher than those in the nontransfused group (18.9 ± 3.7%, 23.1 ± 4.1%) (P < .05). There was no significant difference between the group's arterial lactate levels immediately after admission to the intensive care unit and 1 day after the operation. The arterial lactate levels 6 hours after the admission to the intensive care unit for the nontransfused patients were higher than with the transfused patients (4.3 ± 3.0 versus 2.5 ± 1.5 mmol/L, (P < .05). For arterial lactate level, the relation with patients' weight had the highest correlation (R = 0.678, P < .0001).

CONCLUSIONS: A criterion-driven transfusion program can be effective, and low-hematocrit bypass with a hematocrit value below 20% may affect lactate production or clearance from the body.

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				K. Miyaji, S. Kohira, T. Miyamoto, K. Nakashima, H. Sato, K. Ohara, and H. Yoshimura Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 284 - 289. [Abstract] [Full Text] [PDF]

				R. A. Jonas Hematocrit trial J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1200 - 1200. [Full Text] [PDF]

				Y. Ootaki, M. Yamaguchi, and N. Yoshimura Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1201 - 1202. [Full Text] [PDF]