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

Abstract

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. 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. 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). 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.