Impact of On-Bypass Red Blood Cell Transfusion on Severe Postoperative Morbidity or Mortality in Children.

BACKGROUND: Children undergoing cardiac surgery are frequently exposed to red blood cell (RBC) transfusions mainly in the case of hemorrhage or low oxygen transport. However, in this population, RBCs are sometimes added to the cardiopulmonary bypass (CPB) priming solution to maintain a predefined hematocrit on bypass. In this study, we investigated the impact of RBCs added to the CPB on severe postoperative morbidity or mortality. METHODS: This retrospective cohort study was conducted between 2006 and 2012 in a tertiary care level, children's hospital. Children receiving red cells only to prime the CPB (CPB transfusion) were compared with those receiving no RBCs during their entire hospital stay. The primary outcome was severe postoperative morbidity or mortality. Studied secondary outcomes were neurologic deficit, infection, length of mechanical ventilation, pediatric intensive care unit and hospital length of stay, and mortality. Both groups were compared with propensity score analysis where patients were matched via a genetic matching algorithm. In all analyses, applying a Bonferroni correction, a P value <.05 .00625 was considered statistically significant. results: among the patients retained for this study received no rbc transfusion during their entire hospital stay and a cpb transfusion. thirty-five in no-transfusion group developed severe postoperative morbidity or died. difference significant using univariate analysis .001 propensity score showed that died compared with .043 relative risk its bonferroni-corrected confidence interval all secondary outcomes were not significantly different between both groups except number of who infections conclusions: condition our adding rbcs to priming maintain predefined hematocrit does seem impact markedly mortality children undergoing cardiac surgery. only infection increased group. further studies are warranted better understand complex interaction severity illness anemia outcome international anesthesia research society>

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