Blood conservation pediatric cardiac surgery in all ages and complexity levels

Table 1 Perfusion technique and equipment

Equipment and technique	NC	BC
Integrated arterial filter with oxygenator	N	Y
Retrograde arterial priming	N	Y
Modified ultrafiltration	Y/N1	Y
In-line blood gas analyzer	N/Y1	Y
Point of care blood micro sampling	Y	Y
Cerebral saturation	Y	Y
Mixed venous saturation	Y	Y
Pediatric cell salvage	N	Y

¹Some did and some did not. BC: Blood conservation; NC: Non-conservation; Y: Yes; N: No.

Table 2 Cardiopulmonary bypass circuit prime volume

Body weight (kg)	NC (mL)	BC (mL)	Reduction (%)
Neonate-12	400	160	60
12-35	600	445	26
35-55	800	520	35
55-75	1000	765	24
> 75	1000	880	12

BC: Blood conservation; NC: Non-conservation.

Table 3 Intraoperative variables in age categories for blood conservation and non-conservation cohorts

Operative variables	NC neonate n = 28 (12%)	BC neonate n = 23 (16%)	P	NC infant n = 69 (32%)	BC infant n = 52 (38%)	P	NC child n = 76 (35%)	BC child n = 29 (21%)	P	NC adolescent n = 45 (21%)	BC adolescent n = 34 (25%)	P
Average age (d)	10 ± 9	12 ± 10	0.08	187 ± 109	139 ± 86	0.001	1638 ± 806	1730 ± 1012	0.44	6280 ± 1977	6671 ± 3103	0.78
Weight (kg)	3 ± 0.7	3 ± 1	0.94	6 ± 2	6 ± 2	0.3	19 ± 9	20 ± 9	0.49	60 ± 20	57 ± 17	0.19
% Male	60%	52%	0.35	45%	35%	0.59	45%	52%	0.83	69%	47%	0.07
Bypass (min)	161 ± 74	136 ± 53	0.15	124 ± 66	85 ± 39	< 0.001	83 ± 48	71 ± 45	0.04	116 ± 63	106 ± 59	0.54
Cross clamp (min)	75 ± 47	75 ± 39	0.99	74 ± 45	45 ± 30	< 0.001	37 ± 38	30 ± 32	0.16	46 ± 53	57 ± 46	0.3
Pre-operative Hct (%)	32 ± 2	37 ± 5	0.11	30 ± 5	32 ± 7	0.19	31 ± 4	31 ± 5	0.63	32 ± 7	34 ± 4	0.26
Pre-bypass Hct (%)	36 ± 7	35 ± 6	0.19	30 ± 6	31 ± 7	0.89	33 ± 5	31 ± 5	0.1	34 ± 5	33 ± 3	0.54
On-bypass Hct (%)	25 ± 3	23 ± 3	0.07	25 ± 3	23 ± 3	0.09	24 ± 3	23 ± 3	0.1	25 ± 3	28 ± 3	< 0.001
Post-bypass Hct (%)	47 ± 4	34 ± 5	0.001	35 ± 5	34 ± 4	0.3	31 ± 5	32 ± 4	0.75	28 ± 3	34 ± 4	< 0.001
Operative RBC (mL/kg)	236 ± 220	97 ± 34	0.01	90 ± 58	49 ± 24	< 0.001	25 ± 26	11 ± 10	0.01	5 ± 13	0.4 ± 2	0.02
RBC exposure (unit)	2 ± 0.5	1.0 ± 0.2	< 0.001	1.6 ± 0.7	0.8 ± 0.3	< 0.001	1.2 ± 0.9	0.6 ± 0.6	0.002	0.9 ± 2	0.04 ± 0.2	0.02

BC: Blood conservation; NC: Non-conservation; RBC: Red blood cell; Hct: Hematocrit.

Table 4 Intraoperative variables in STAT categories for blood conservation and non-conservation cohorts

Operative variables	NC STAT 1 n = 118 (54%)	BC STAT 1 n = 73 (53%)	P	NC STAT 2 n = 53 (24%)	BC STAT 2 n = 25 (18%)	P	NC STAT 3 n = 29 (13%)	BC STAT 3 n = 15 (11%)	P	NC TAT 4 n = 17 (8%)	BC STAT 4 n = 21 (15%)	P
Average age (d)	2419 ± 2667	3088 ± 3498	0.12	1500 ± 1947	1012 ± 2176	0.001	899 ± 1762	619 ± 1659	0.62	1724 ± 3559	1447 ± 2817	0.81
Weight (kg)	27 ± 26	29 ± 24	0.53	17 ± 18	15 ± 23	0.58	11 ± 13	9 ± 12	0.65	16 ± 25	14 ± 21	0.81
% Male	58%	42%	0.07	47%	56%	0.63	45%	40%	0.76	47%	38%	0.74
Bypass (min)	82 ± 37	74 ± 39	0.2	127 ± 68	94 ± 47	0.03	185 ± 73	131 ± 73	0.02	155 ± 66	132 ± 49	0.22
Cross clamp (min)	42 ± 29	38 ± 31	0.35	59 ± 55	43 ± 43	0.21	87 ± 64	81 ± 45	0.77	81 ± 58	71 ± 37	0.52
Pre-operative Hct (%)	31 ± 4	31 ± 4	0.77	29 ± 5	36 ± 8	0.09	34 ± 11	34 ± 6	0.95	37 ± 8	37 ± 7	0.7
Pre-bypass Hct (%)	31 ± 4	30 ± 4	0.62	35 ± 8	33 ± 7	0.39	35 ± 7	32 ± 6	0.14	35 ± 7	35 ± 6	0.7
On-bypass Hct (%)	24 ± 3	25 ± 4	0.07	25 ± 4	25 ± 4	0.45	25 ± 4	23 ± 3	0.04	25 ± 3	24 ± 4	0.37
Post-bypass Hct (%)	31 ± 4	33 ± 3	0.02	35 ± 5	36 ± 4	0.63	38 ± 5	32 ± 3	0.02	39 ± 12	34 ± 5	0.39
Operative RBC (mL/kg)	36 ± 50	21 ± 30	0.02	66 ± 65	40 ± 39	0.03	115 ± 78	53 ± 31	0.03	219 ± 301	64 ± 47	0.05
RBC exposure (unit)	0.9 ± 0.7	0.5 ± 0.6	< 0.001	1.7 ± 1	0.7 ± 0.4	< 0.001	2.2 ± 2.2	0.8 ± 0.5	< 0.001	2.0 ± 0.9	0.7 ± 0.4	< 0.001

BC: Blood conservation; NC: Non-conservation; RBC: Red blood cell; Hct: Hematocrit; STAT: Society of Thoracic Surgeon and European Association for Cardio-Thoracic Surgery Mortality Score.