OBJECTIVE: To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients. DESIGN: Randomized controlled trial. SETTING: Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands. PATIENTS: One hundred seven patients with non-cyanotic congenital heart defects between 6 weeks and 6 years of age. One hundred three patients underwentcorrective surgery on cardiopulmonary bypass. INTERVENTIONS: Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l). MEASUREMENTS: Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis). RESULTS: In the restrictive transfusion group, mean volume of transfused RBC was 186 (±70) ml per patient and in the liberal transfusion group 258 (±87) ml per patient, (95% CI 40.6-104.6), p < 0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p = 0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (±203.39) vs. 316.27 (±189.96) euros (95% CI 46.61-197.51) per patient in the restrictive transfusion group, p = 0.002. CONCLUSIONS: For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, arestrictive RBC transfusion policy (threshold of Hb 8.0 g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive.
RCT Entities:
OBJECTIVE: To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients. DESIGN: Randomized controlled trial. SETTING: Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands. PATIENTS: One hundred seven patients with non-cyanotic congenital heart defects between 6 weeks and 6 years of age. One hundred three patients underwent corrective surgery on cardiopulmonary bypass. INTERVENTIONS: Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l). MEASUREMENTS: Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis). RESULTS: In the restrictive transfusion group, mean volume of transfused RBC was 186 (±70) ml per patient and in the liberal transfusion group 258 (±87) ml per patient, (95% CI 40.6-104.6), p < 0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p = 0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (±203.39) vs. 316.27 (±189.96) euros (95% CI 46.61-197.51) per patient in the restrictive transfusion group, p = 0.002. CONCLUSIONS: For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0 g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive.
Authors: George M Hoffman; Kathleen A Mussatto; Cheryl L Brosig; Nancy S Ghanayem; Ndidiamaka Musa; Raymond T Fedderly; Robert D B Jaquiss; James S Tweddell Journal: J Thorac Cardiovasc Surg Date: 2005-10 Impact factor: 5.209
Authors: J S Tweddell; G M Hoffman; R T Fedderly; N S Ghanayem; J M Kampine; S Berger; K A Mussatto; S B Litwin Journal: Ann Thorac Surg Date: 2000-06 Impact factor: 4.330
Authors: Jacques Lacroix; Paul C Hébert; James S Hutchison; Heather A Hume; Marisa Tucci; Thierry Ducruet; France Gauvin; Jean-Paul Collet; Baruch J Toledano; Pierre Robillard; Ari Joffe; Dominique Biarent; Kathleen Meert; Mark J Peters Journal: N Engl J Med Date: 2007-04-19 Impact factor: 91.245
Authors: Lise J Estcourt; Reem Malouf; Marialena Trivella; Dean A Fergusson; Sally Hopewell; Michael F Murphy Journal: Cochrane Database Syst Rev Date: 2017-01-27
Authors: Nadine Shehata; Nikhil Mistry; Bruno R da Costa; Tiago V Pereira; Richard Whitlock; Gerard F Curley; David A Scott; Gregory M T Hare; Peter Jüni; C David Mazer Journal: Eur Heart J Date: 2019-04-01 Impact factor: 29.983
Authors: Jeffrey S Upperman; John C Bucuvalas; Felicia N Williams; Bruce A Cairns; Charles S Cox; Allan Doctor; Robert F Tamburro Journal: Pediatr Crit Care Med Date: 2017-03 Impact factor: 3.624
Authors: Rahul Dasgupta; Andrew Parsons; Sarenthia Mcclelland; Elizabeth Morgan; Michael J Robertson; Tommy R Noel; Michael L Schmitz; Mallikarjuna Rettiganti; Punkaj Gupta Journal: Blood Transfus Date: 2014-11-25 Impact factor: 3.443