Skip to main content
Erschienen in: Pediatric Cardiology 6/2015

01.08.2015 | Original Article

Association of Hematocrit and Red Blood Cell Transfusion with Outcomes in Infants Undergoing Norwood Operation

verfasst von: Punkaj Gupta, Caitlin King, Lisle Benjamin, Timothy Goodhart, Michael J. Robertson, Jeffrey M. Gossett, Gina A. Pesek, Rahul DasGupta

Erschienen in: Pediatric Cardiology | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

The objective of this study was to investigate the association between red blood cell (RBC) transfusion and hematocrit values with outcomes in infants undergoing Norwood operation. This study included infants ≤2 months of age who underwent Norwood operation with either a modified Blalock–Taussig shunt or a right ventricle-pulmonary artery shunt. Demographics, preoperative, operative, daily laboratory data, and postoperative variables were collected. The primary outcome measures evaluated included mortality, ICU length of stay, length of mechanical ventilation, and days to chest closure. The secondary outcome measures evaluated included lactate levels, estimated glomerular filtration rate, and inotrope score in the first 14 days after heart operation. Cox proportional hazard models were fitted to study the probability of study outcomes as a function of hematocrit values and RBC transfusions after operation. Eighty-nine patients qualified for inclusion. With a median hematocrit of 46 (IQR 44, 49), and a median RBC transfusion of 92 ml/kg (IQR 31, 384) in the first 14 days after operation, 81 (91 %) patients received RBC transfusions. A multivariable analysis adjusted for risk factors, including the age, weight, prematurity, cardiopulmonary bypass and cross-clamp time, and postoperative need for nitric oxide and dialysis, demonstrated no association between hematocrit and RBC transfusion with majority of study outcomes. This single-center study found that higher hematocrit values and increasing RBC transfusions are not associated with improved outcomes in infants undergoing Norwood operation.
Literatur
1.
Zurück zum Zitat Armano R, Gauvin F, Ducruet T, Lacroix J (2005) Determinants of red blood cell transfusions in a pediatric critical care unit: a prospective, descriptive epidemiological study. Crit Care Med 33:2637–2644PubMedCrossRef Armano R, Gauvin F, Ducruet T, Lacroix J (2005) Determinants of red blood cell transfusions in a pediatric critical care unit: a prospective, descriptive epidemiological study. Crit Care Med 33:2637–2644PubMedCrossRef
2.
Zurück zum Zitat Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, Jacobs B, Markovitz B, Goldstein B, Hanson JH, Li HA, Randolph AG (2008) Anemia, blood loss and blood transfusion in North American children in the intensive care unit. Am J Respir Crit Care Med 178:26–33PubMedCrossRef Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, Jacobs B, Markovitz B, Goldstein B, Hanson JH, Li HA, Randolph AG (2008) Anemia, blood loss and blood transfusion in North American children in the intensive care unit. Am J Respir Crit Care Med 178:26–33PubMedCrossRef
3.
Zurück zum Zitat Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, Mulherin MA, Zhu H, Buck RD, Califf RM, McMahon TJ (2007) Evolution of adverse changes in stored RBCS. Proc Natl Acad Sci 104:17063–17068PubMedCentralPubMedCrossRef Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, Mulherin MA, Zhu H, Buck RD, Califf RM, McMahon TJ (2007) Evolution of adverse changes in stored RBCS. Proc Natl Acad Sci 104:17063–17068PubMedCentralPubMedCrossRef
4.
Zurück zum Zitat Blackwood J, Joffe AR, Robertson CM, Dinu IA, Alton G, Penner K, Ross DB, Rebeyka IM (2010) Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 89(5):1378-84.e1–1378-84.e2CrossRef Blackwood J, Joffe AR, Robertson CM, Dinu IA, Alton G, Penner K, Ross DB, Rebeyka IM (2010) Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 89(5):1378-84.e1–1378-84.e2CrossRef
5.
Zurück zum Zitat Chin-Yee I, Arya N, d’Almeida MS (1997) The red cell storage lesion and its implications for transfusion. Transfus Sci 18:447–458PubMedCrossRef Chin-Yee I, Arya N, d’Almeida MS (1997) The red cell storage lesion and its implications for transfusion. Transfus Sci 18:447–458PubMedCrossRef
6.
Zurück zum Zitat Cholette JM, Rubenstein JS, Alfieris GM, Powers KS, Eaton M, Lerner NB (2011) Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 12(1):39–45PubMedCrossRef Cholette JM, Rubenstein JS, Alfieris GM, Powers KS, Eaton M, Lerner NB (2011) Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 12(1):39–45PubMedCrossRef
7.
Zurück zum Zitat Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52PubMedCrossRef Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52PubMedCrossRef
8.
Zurück zum Zitat de Gast-Bakker DH, de Wilde RB, Hazekamp MG, Sojak V, Zwaginga JJ, Wolterbeek R, de Jonge E, Gesink-van der Veer BJ (2013) Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Med 39(11):2011–2019PubMedCrossRef de Gast-Bakker DH, de Wilde RB, Hazekamp MG, Sojak V, Zwaginga JJ, Wolterbeek R, de Jonge E, Gesink-van der Veer BJ (2013) Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Med 39(11):2011–2019PubMedCrossRef
9.
Zurück zum Zitat Guzzetta NA (2010) Benefits and risks of red blood cell transfusion in pediatric patients undergoing cardiac surgery. Pediatr Anesth 21:504–511CrossRef Guzzetta NA (2010) Benefits and risks of red blood cell transfusion in pediatric patients undergoing cardiac surgery. Pediatr Anesth 21:504–511CrossRef
10.
Zurück zum Zitat Hebert PC, Tinmouth A, Corwin HL (2007) Controversies in RBC transfusion in the critically ill. Chest 131:1583–1590PubMedCrossRef Hebert PC, Tinmouth A, Corwin HL (2007) Controversies in RBC transfusion in the critically ill. Chest 131:1583–1590PubMedCrossRef
11.
Zurück zum Zitat Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417PubMedCrossRef Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417PubMedCrossRef
12.
Zurück zum Zitat Howard-Quijano K, Schwarzenberger JC, Scovotti JC, Alejos A, Ngo J, Gornbein J, Mahajan A (2013) Increased red blood cell transfusions are associated with worsening outcomes in pediatric heart transplant patients. Anesth Analg 116(6):1295–1308PubMedCrossRef Howard-Quijano K, Schwarzenberger JC, Scovotti JC, Alejos A, Ngo J, Gornbein J, Mahajan A (2013) Increased red blood cell transfusions are associated with worsening outcomes in pediatric heart transplant patients. Anesth Analg 116(6):1295–1308PubMedCrossRef
13.
Zurück zum Zitat Kneyber MC, Hersi MI, Twisk JW, Markhorst DG, Plotz FB (2007) Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med 33:1414–1422PubMedCrossRef Kneyber MC, Hersi MI, Twisk JW, Markhorst DG, Plotz FB (2007) Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med 33:1414–1422PubMedCrossRef
14.
Zurück zum Zitat Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS (2002) Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 73(2):538–545PubMedCrossRef Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS (2002) Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 73(2):538–545PubMedCrossRef
15.
Zurück zum Zitat Kwiatkowski JL, Manno CS (1999) Blood transfusion support in pediatric cardiovascular surgery. Transfus Sci 21:63–72PubMedCrossRef Kwiatkowski JL, Manno CS (1999) Blood transfusion support in pediatric cardiovascular surgery. Transfus Sci 21:63–72PubMedCrossRef
16.
Zurück zum Zitat Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ (2007) Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 356:1609–1619PubMedCrossRef Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ (2007) Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 356:1609–1619PubMedCrossRef
17.
Zurück zum Zitat Lavoie J (2011) Blood Transfusion risks and alternative strategies in pediatric patients. Pediatr Anesth 21:14–24CrossRef Lavoie J (2011) Blood Transfusion risks and alternative strategies in pediatric patients. Pediatr Anesth 21:14–24CrossRef
18.
Zurück zum Zitat Marik PE, Corwin HL (2008) Efficacy of red blood transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674PubMedCrossRef Marik PE, Corwin HL (2008) Efficacy of red blood transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674PubMedCrossRef
19.
Zurück zum Zitat Reynolds JD, Ahearn GS, Angelo M, Zhang J, Cobb F, Stamler JS (2007) S nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in banked blood. Proc Natl Acad Sci 104:17058–17062PubMedCentralPubMedCrossRef Reynolds JD, Ahearn GS, Angelo M, Zhang J, Cobb F, Stamler JS (2007) S nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in banked blood. Proc Natl Acad Sci 104:17058–17062PubMedCentralPubMedCrossRef
20.
Zurück zum Zitat Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20(3):629–637PubMedCentralPubMedCrossRef Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20(3):629–637PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Szekely A, Cserep Z, Sapi E, Breuer T, Nagy CA, Vargha P, Hartyanszky I, Szatmari A, Treszel A (2009) Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg 87:187–197PubMedCrossRef Szekely A, Cserep Z, Sapi E, Breuer T, Nagy CA, Vargha P, Hartyanszky I, Szatmari A, Treszel A (2009) Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg 87:187–197PubMedCrossRef
22.
Zurück zum Zitat Tinmouth A, Chin-Yee I (2001) The clinical consequences of the red cell storage lesion. Transfus Med Rev 15:91–107PubMedCrossRef Tinmouth A, Chin-Yee I (2001) The clinical consequences of the red cell storage lesion. Transfus Med Rev 15:91–107PubMedCrossRef
23.
Zurück zum Zitat Willems A, Harrington K, Lacroix J, Biarent D, Joffe AR, Wensley D, Ducruet T, Hébert PC, Tucci M (2010) Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 38:649–656PubMedCrossRef Willems A, Harrington K, Lacroix J, Biarent D, Joffe AR, Wensley D, Ducruet T, Hébert PC, Tucci M (2010) Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 38:649–656PubMedCrossRef
Metadaten
Titel
Association of Hematocrit and Red Blood Cell Transfusion with Outcomes in Infants Undergoing Norwood Operation
verfasst von
Punkaj Gupta
Caitlin King
Lisle Benjamin
Timothy Goodhart
Michael J. Robertson
Jeffrey M. Gossett
Gina A. Pesek
Rahul DasGupta
Publikationsdatum
01.08.2015
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 6/2015
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1147-z

Weitere Artikel der Ausgabe 6/2015

Pediatric Cardiology 6/2015 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.