Abstract 13200: The Effect of Cardiopulmonary Bypass Prime Volume on the Need for Blood Transfusion After Pediatric Cardiac Surgery
Background: Transfusion of red blood cells (RBC) after pediatric cardiac surgery has been associated with negative clinical outcomes. Despite reports of decreased transfusion requirements associated with smaller cardiopulmonary bypass (CPB) circuit prime volume; this relationship has not been systematically examined.
Methods: All pediatric patients at our institution who underwent cardiac surgery requiring CPB between 1/2005 and 12/2010 were reviewed. Demographics and intraoperative data were queried from a prospective institutional database. The medical record was assessed for administration of RBC transfusions. CPB prime volume was indexed by patient body surface area. Logistic regression analysis was used to correlate these variables to the need for RBC transfusion.
Results: 2278 patients were identified for analysis; 1873 received a RBC transfusion in the perioperative period and 305 did not. In univariate analysis, indexed CPB prime volume was a significant predictor of the need for RBC transfusion (OR=1.008, p<0.001). Other variables of significance included age, surgeon, RACHS-1 category, CPB time, aortic cross-clamp time, duration of deep hypothermic circulatory arrest, minimal core temperature, and CPB indexed flow rate. Prior cardiac surgery was not a significant predictor. In multivariate analysis controlling for surgeon and minimal core temperature, CPB prime volume, [OR 1.007, 95% CI 1.006-1.008, p<0.001], and RACHS-1 category (p=0.001) remained as independent predictors of the risk of requiring transfusion. Modeling of these odds (see figure) results in a 2-fold change in risk of transfusion for a change of as little as 20cc in CPB prime volume for a patient with a BSA of 0.2 m2.
Conclusions: The need for blood transfusion in pediatric cardiac surgery patients during the perioperative period is independently related to the prime volume of the CPB circuit. Minimizing the prime volume even modestly can significantly impact this risk.
- © 2011 by American Heart Association, Inc.