BACKGROUND: Cell salvage (CS) techniques are used to reduce exposure to allogeneic
packed red blood cell (pRBC) transfusion in patients undergoing cardiac surgery.
However, some studies suggest that inappropriate use of these techniques
is associated with increased incidences of thrombocytopenia,
excessive bleeding, and transfusion of non-red blood cell blood products,
including fresh frozen plasma (FFP), cryoprecipitate, and platelets. Pediatric
patients undergoing cardiac surgery are at higher risk for increased perioperative
bleeding and blood product transfusion requirement. To date, limited evidence
supports the use of CS to reduce pRBC transfusion in neonates and children
undergoing cardiac surgery.
OBJECTIVES: This study analyzed the efficacy of systematic use of CS in neonates and
children undergoing cardiac surgery with cardiopulmonary bypass (CPB)
compared to a historic cohort of children in whom CS was not used. Our primary
endpoints included the incidences of pRBC, cryoprecipitate, and platelets
transfusion occurring within 48 hours after CPB.
METHODS: We performed a retrospective medical chart review to study all neonates
and children who underwent cardiac surgery with CPB between January 2013
and December 2014 at Boston Children’s Hospital (BCH). Considering that CS
has been systematically applied at BCH since January 2014, children were
separated into a control group (before January 2014) and a CS group (after
January 2014). Children treated with CS before January
2014 were excluded. We used uni- and multivariable logistic regression analysis
to assess the effect of CS on the odds of blood products transfusion.
RESULTS: Among 1228 patients included in the analysis, 730 were included in
the CS group and 498 in the control group. The results of our multivariate logistic
regression analysis showed that age < 12 months (odds ratio (OR): 2.95, 95%
confidence interval (CI): 2.26-3.84), American Society of Anesthesiologists
Physical Status Classification (ASA) > 3 (OR: 2.95, 95% CI: 2.26-3.84), Risk
Adjustment for Congenital Heart Surgery score (RACHS) > 3 (OR: 1.78, 95% CI:
1.28-2.49), and the use of CS (OR: 0.57, 95% CI: 0.44-0.73) were good
predictors for perioperative transfusion. Using univariable analysis, the use of CS
was associated with a significant reduction in pRBC transfusion (OR: 0.76, 95%
CI: 0.61-0.96, p = 0.021), but a significant increase in cryoprecipitate (OR: 1.37,
95% CI: 1.08-1.76, p = 0.009) and platelets transfusions (OR: 1.37 95% CI: 1.08-
1.76, p = 0.004). However, after adjustment for age < 12 months, ASA > 3, and
RACHS > 3, the use of CS significantly reduced pRBC transfusion (OR: 0.57,
95% CI: 0.44-0.73, p < 0.001), with no effect on cryoprecipitate (OR: 1.08, 95%
CI: 0.83-1.41, p = 0.543) and platelets transfusions (OR: 1.05, 95% CI: 0.81-1.36,
p = 0.694).
CONCLUSION: The use of CS in neonates and children undergoing cardiac surgery with
CPB significantly reduced the incidence of pRBC transfusion.
Although the systematic use of CS in adults has been associated with an
increased incidence of non-pRBC transfusions, the use of CS in a high
risk pediatric population (age < 12 months, ASA > 3, RACHS > 3) was
associated with a 43% reduction of pRBC transfusion without any increases in
cryoprecipitate and platelets transfusions.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/17042 |
| Date | 20 June 2016 |
| Creators | Stevens, William N. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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