Association of Blood Products Administration During Cardiopulmonary Bypass and Excessive Post-operative Bleeding in Pediatric Cardiac Surgery

Hemant S. Agarwal*, Sarah S. Barrett, Kristen Barry, Meng Xu, Benjamin R. Saville, Brian S. Donahue, Zena Leah Harris, David P. Bichell

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Our objectives were to study risk factors and post-operative outcomes associated with excessive post-operative bleeding in pediatric cardiac surgeries performed using cardiopulmonary bypass (CPB) support. A retrospective observational study was undertaken, and all consecutive pediatric heart surgeries over 1 year period were studied. Excessive post-operative bleeding was defined as 10 ml/kg/h of chest tube output for 1 h or 5 ml/kg/h for three consecutive hours in the first 12 h of pediatric cardiac intensive care unit (PCICU) stay. Risk factors including demographics, complexity of cardiac defect, CPB parameters, hematological studies, and post-operative morbidity and mortality were evaluated for excessive bleeding. 253 patients were studied, and 107 (42 %) met the criteria for excessive bleeding. Bayesian model averaging revealed that greater volume of blood products transfusion during CPB was significantly associated with excessive bleeding. Multiple logistic regression analysis of blood products transfusion revealed that increased volume of packed red blood cells (PRBCs) administration for CPB prime and during CPB was significantly associated with excessive bleeding (p = 0.028 and p = 0.0012, respectively). Proportional odds logistic regression revealed that excessive bleeding was associated with greater time to achieve negative fluid balance, prolonged mechanical ventilation, and duration of PCICU stay (p < 0.001) after adjusting for multiple parameters. A greater volume of blood products administration, especially PRBCs transfusion for CPB prime, and during the CPB period is associated with excessive post-operative bleeding. Excessive bleeding is associated with worse post-operative outcomes.

Original languageEnglish (US)
Pages (from-to)459-467
Number of pages9
JournalPediatric cardiology
Volume36
Issue number3
DOIs
StatePublished - Feb 20 2015

Keywords

  • Bayesian
  • Blood transfusion
  • Cardiopulmonary bypass (CPB)
  • Complications
  • Inflammatory response
  • Outcomes
  • Pediatric
  • Statistics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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