Assessing the Efficacy of Pathogen-Reduced Platelet Transfusions for Hemostasis in Children Undergoing Cardiopulmonary Bypass Surgery.

Abstract

Children undergoing cardiopulmonary bypass (CPB) surgery are vulnerable to bleeding and often require transfusions. Pathogen-reduced (PR) platelets may reduce microbial contamination but are associated with decreased platelet count increments and increased transfusions. We sought to evaluate hemostasis in children undergoing CPB surgery receiving PR platelets vs large-volume delayed sampling (LVDS) platelets. We performed a retrospective review of children in a cardiac intensive care unit after CPB surgery from 2020 to 2022. Demographics, operative characteristics, transfusion details, and outcomes were compared. The primary outcome was postoperative chest tube bleeding in the first 24 hours. There were 522 patients enrolled; 47% (243/522) received LVDS platelets and 53% (279/522) received PR platelets. Median (interquartile range) age was 4 (0-29) months. There were no differences in age (P = .499) or The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery congenital heart surgery mortality score (P = .813). There were no differences between platelet groups in postoperative chest tube bleeding at 1 hour (2.9 vs 3.2 mL/kg; P = .179), 2 hours (4.9 vs 5.1 mL/kg; P = .368), 4 hours (7.7 vs 8.1 mL/kg; P = .433), 8 hours (11.9 vs 12.9 mL/kg; P = .610), 12 hours (17.0 vs 17.1 mL/kg; P = .966), or 24 hours (28.0 vs 27.0 mL/kg; P = .536) after surgery. There were also no differences in doses of red blood cells (P = .054), cell salvage (P = .220), plasma (P = .337), or cryoprecipitate (P = .091). Children who received PR platelets had the same amount of chest tube output and did not require increased transfusions compared with LVDS platelet recipients. In children undergoing CPB surgery, PR platelets appeared to provide adequate hemostasis with further theoretical benefit of reduced microbial contamination.