JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

 Click here to read this article as a CME activity

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Colleen E. Gruenwald
Brian W. McCrindle
Glen Van Arsdell
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gruenwald, C. E.
Right arrow Articles by Van Arsdell, G.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Gruenwald, C. E.
Right arrow Articles by Van Arsdell, G.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Congenital - cyanotic
Right arrow Extracorporeal circulation

J Thorac Cardiovasc Surg 2008;136:1442-1449
© 2008 The American Association for Thoracic Surgery

Congenital Heart Disease

Reconstituted fresh whole blood improves clinical outcomes compared with stored component blood therapy for neonates undergoing cardiopulmonary bypass for cardiac surgery: A randomized controlled trial

Colleen E. Gruenwald, MHSc, RN, CCP, CPCb,*, Brian W. McCrindle, MD, MPHc, Lynn Crawford-Lean, BSc, RRT, CCP, CPCb, Helen Holtby, MDd, Christopher Parshuram, MBChB, D Phile, Patricia Massicotte, MSc, MD, FRCPC, MHScf, Glen Van Arsdell, MDa

a Labatt Family Heart Centre, Department of Cardiovascular Surgery, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
b Labatt Family Heart Centre, Department of Perfusion, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
c Labatt Family Heart Centre, Department of Cardiology, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
d Labatt Family Heart Centre, Department of Anaesthesia, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
e Labatt Family Heart Centre, Department of Critical Care Medicine, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
f Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada

Received for publication January 24, 2008; revisions received July 9, 2008; accepted for publication August 28, 2008.

* Address for reprint: Colleen E. Gruenwald, MHSc, RN, CCP, CPC, Perfusion Services, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada, M5G 1X8. (Email: colleen.gruenwald{at}sickkids.ca).

Objective: This study compared the effects of reconstituted fresh whole blood against standard blood component therapy in neonates undergoing cardiac surgery.

Methods: Patients less than 1 month of age were randomized to receive either reconstituted fresh whole blood (n = 31) or standard blood component therapy (n = 33) to prime the bypass circuit and for transfusion during the 24 hours after cardiopulmonary bypass. Primary outcome was chest tube drainage; secondary outcomes included transfusion needs, inotrope score, ventilation time, and hospital length of stay.

Results: Patients who received reconstituted fresh whole blood had significantly less postoperative chest tube volume loss per kilogram of body weight (7.7 mL/kg vs 11.8 mL/kg; P = .03). Standard blood component therapy was associated with higher inotropic score (6.6 vs 3.3; P = .002), longer ventilation times (164 hours vs 119 hours; P = .04), as well as longer hospital stays (18 days vs 12 days; P = .006) than patients receiving reconstituted fresh whole blood. Of the different factors associated with the use of reconstituted fresh whole blood, lower platelet counts at 10 minutes and at the end of cardiopulmonary bypass, older age of cells used in the prime and throughout bypass, and exposures to higher number of allogeneic donors were found to be independent predictors of poor clinical outcomes.

Conclusions: Reconstituted fresh whole blood used for the prime, throughout cardiopulmonary bypass, and for all transfusion requirements within the first 24 hours postoperatively results in reduced chest tube volume loss and improved clinical outcomes in neonatal patients undergoing cardiac surgery.

Abbreviations and Acronyms ACT = activated clotting time; CBS = Canadian Blood Services; CCCU = cardiac critical care unit; CPB = cardiopulmonary bypass; DHCA = deep hypothermic circulatory arrest; IL-8 = interleukin 8; PRBC = packed red blood cell; RFWB = reconstituted fresh whole blood; TNF = tumor necrosis factor






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.