Abstract 1918: Reconstituted Fresh Whole Blood Improves Clinical Outcomes Compared to Stored Component Blood Therapy for Neonates Undergoing Cardiopulmonary Bypass for Cardiac Surgery
Background Neonatal patients undergoing cardiopulmonary bypass may have important morbidity associated with bleeding during the peri-operative period. This study compared the clinical effects of using reconstituted fresh whole blood (RFWB) against standard blood component therapy (SBCT) for blood transfusion requirements during neonatal cardiac surgery.
Methods A randomized controlled trial was performed. Eligible patients were less than one month of age and undergoing elective open-heart surgery. Enrolled patients were randomized to receive either RFWB (n=31) or SBCT (n=33) to prime the bypass circuit and for transfusion requirements during the 24 hours following bypass. Primary outcome was bleeding; secondary outcomes were inotropic score, ventilation time and hospital length of stay.
Results As per study design, patients who received RFWB were exposed to fewer allogeneic blood donors in the first 24 hours following surgery (3.2 vs. 6.9 units, p<0.0001) and received significantly fresher blood (2 vs. 14 days, p<0.0001) than patients receiving SBCT. RFWB was associated with significantly less post-operative chest tube volume loss per kilogram (kg) of body weight (27 vs. 40 mls/kg, p=0.03). SBCT was associated with higher inotropic score 24 hours post-surgery (6.9 vs. 3.3, p=0.002), longer ventilation times, (164 vs. 119 hours, p=0.04), as well as longer hospital stays (18 vs. 12 days, p=0.006) than patients receiving RFWB. In multivariable regression models, older age of cells used in the prime and throughout cardiopulmonary bypass, exposure to a higher number of allogeneic blood donors and lower platelet counts at 10 minutes and at the end of bypass were found to be independent predictors of negative clinical outcomes.
Conclusions RFWB utilized for the prime, throughout cardio-pulmonary bypass and for all transfusion requirements within the first 24 hours postoperatively results in reduced bleeding and improved clinical outcomes compared to SBCT in neonatal patients undergoing cardiac surgery.