Minimisation of priming volume and blood saving in paediatric cardiac surgery.

We started a programme of donor blood reduction for open heart surgery in children in 1983. At first, only meticulous surgical and perfusion techniques were used. Later, increased haemodilution was added. Miniaturisation of the perfusion circuit and introduction of blood taken prior from the patient further decreased donor blood requirements. In 1989, we used 0.89 l per patient compared to 3.2 l per patient in 1983. Miniaturisation of the circuit was tested in a pilot study on 30 children undergoing the Senning operation in 1988. Priming volume was reduced from 661 +/- 72 ml to 421 +/- 62 ml. In 1989, 167 out of 194 children (86%) received a clear prime. Ninety-seven of 100 children whose weight was over 15 kg received a clear prime: 55 did not require subsequent transfusion. Prime miniaturisation and autotransfusion can considerably reduce blood requirements for open heart surgery.