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Whole blood may do more harm than good in pediatric heart surgeries

s conducted between January 1999 and January 2003 at the University of Texas, Southwestern Medical School, Children's Medical Center of Dallas during Mou's fellowship training. He is now in Wake Forest Baptist's Department of Anesthesia, section of pediatric critical care.

Mou said that some surgeons insist on using whole blood that has been donated within 48 hours, believing that it may reduce potential complications from the heart-lung bypass machine, including bleeding and inflammation. Inflammation is the body's response to exposure to a foreign object the plastic tubing through which the blood circulates.

Research in children has shown that blood loss after heart surgery can be minimized if fresh whole blood is used for transfusions. However, until the research by Mou and colleagues, no study had addressed whether this benefit also applies to using fresh, whole blood for priming the heart-lung bypass equipment.

"The notion that fresh, whole blood is critical for optimal outcomes from congenital heart surgery has long been accepted, but had never been tested," says Mou. "Our data indicate that this practice is not superior to standard priming, but more importantly, we have shown that it is detrimental to patients, leading to increased intensive care length of stay and more time on the respirator."

Each year in the United States, about 19,000 infants undergo heart surgery, with the majority requiring cardiopulmonary bypass. While the reconstituted blood may be more expensive (about $110 per operation), the cost associated with a longer intensive care stay is about $5,750, and greatly outweighs the extra cost of the reconstituted blood, the authors said.

"The potential aggregate cost savings from the use of reconstituted blood for bypass priming could be substantial," said Mou.

Before beginning the research, the authors surveyed several children's hospitals, including prominent cardiac centers such as Children's H
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Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4453
Wake Forest University Baptist Medical Center
13-Oct-2004


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