Document Detail

Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery.
MedLine Citation:
PMID:  15052189     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Low-hematocrit bypass is one technique used to prevent allogeneic transfusion during cardiopulmonary bypass. The purpose of this study is to determine the efficacy of a criterion-driven transfusion protocol and the effect of low-hematocrit bypass with moderate hypothermia in pediatric cardiac surgery. METHODS: Seventy-five children who underwent cardiopulmonary bypass with low-hematocrit bypass for repair of congenital heart disease were studied. Criteria for red blood cell transfusion included anemia with a hematocrit level of less than 15% during bypass and 20% after bypass. During cardiopulmonary bypass, venous oxygen saturation, hematocrit values, and regional cerebral oxygenation were continuously monitored. Arterial lactate levels were measured postoperatively. RESULTS: All patients had an uncomplicated perioperative course, and no perioperative death occurred. Twenty-two patients (29.3%) received a transfusion, and 53 (70.7%) patients did not. The hematocrit levels before and after modified ultrafiltration in the transfused group (21.6 +/- 5.5%, 26.6 +/- 6.5%) were significantly higher than those in the nontransfused group (18.9 +/- 3.7%, 23.1 +/- 4.1%) (P <.05). There was no significant difference between the group's arterial lactate levels immediately after admission to the intensive care unit and 1 day after the operation. The arterial lactate levels 6 hours after the admission to the intensive care unit for the nontransfused patients were higher than with the transfused patients (4.3 +/- 3.0 versus 2.5 +/- 1.5 mmol/L, (P <.05). For arterial lactate level, the relation with patients' weight had the highest correlation (R = 0.678, P <.0001). CONCLUSIONS: A criterion-driven transfusion program can be effective, and low-hematocrit bypass with a hematocrit value below 20% may affect lactate production or clearance from the body.
Yoshio Ootaki; Masahiro Yamaguchi; Naoki Yoshimura; Shigeteru Oka; Masahiro Yoshida; Tomomi Hasegawa
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-30     Completed Date:  2004-06-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  953-8     Citation Subset:  AIM; IM    
Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan.
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MeSH Terms
Biological Markers / blood
Body Temperature
Body Weight
Cardiac Surgical Procedures*
Cardiopulmonary Bypass
Child Welfare
Child, Preschool
Erythrocyte Transfusion*
Heart Defects, Congenital / blood,  therapy
Hypothermia, Induced
Infant Welfare
Intensive Care Units, Pediatric
Lactic Acid / metabolism
Oxygen / blood
Prospective Studies
Statistics as Topic
Treatment Outcome
Reg. No./Substance:
0/Biological Markers; 50-21-5/Lactic Acid; 7782-44-7/Oxygen
Comment In:
J Thorac Cardiovasc Surg. 2005 May;129(5):1200; author reply 1201-2   [PMID:  15867817 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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