Transfusion practices among children undergoing cardiac surgery admitted to the Red Cross War Memorial Children's Hospital Paediatrics Intensive Care Unit
Objective- We aimed to describe the use of blood products following cardiac surgery, as well as the outcomes and factors associated with post-operative blood product use Design- Prospective, single centre observational study Setting- Paediatric intensive care unit (PICU) in Cape Town, South Africa Patients- One hundred and twenty-six children <18 years old admitted to the PICU following cardiac surgery between July 2017 and January 2018 Interventions- None Measurements and Main Results- The data was prospectively obtained from blood bank charts, intraoperative and PICU observation charts. Demographic data, intraoperative details and post-operative blood product use were extracted from patient records and entered in a standardised case record form. Fifty three percent of children received blood products following cardiac surgery. The blood products transfused included cryoprecipitate (30.9%), packed red cells (22.2%), albumin (18.3%), fresh frozen plasma FFP (15.9%) and platelet concentrate (15.1%). Low haemoglobin level was commonest indication (86%) for red cell use. Bleeding was the commonest indication for FFP (70%) and cryoprecipitate (67%) use. Thrombocytopenia was the commonest indication (84%) for platelet use while hypotension episodes were predominant (95%) in those who received albumin. The standardized mortality ratio was 3.1 vs 0, respectively, among transfused versus non-transfused patients (p<0.0001). The median (IQR) duration of PICU stay was 5 (3-11) vs 2 (2-5) days, respectively in those transfused versus non-transfused (p<0.0001). The median (IQR) ventilation duration was 47(22-132) hours vs 20 (6-27) hours, respectively among the transfused versus non-transfused (p=<0.0001). The factors associated with blood-product use post cardiac surgery include previous cardiac surgery, younger age, lower weights, and prolonged coagulation parameters (p=<0.05). Conclusion- There is high usage of blood products among children post cardiac surgery. The children transfused had a longer ICU stay, ventilation duration, and higher standardized mortality ratio compared to the non-transfused.
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Department of Paediatrics and Child Health