Volume 116, Issue 9 pp. 965-975

Original Paper

Red blood cell storage duration and peri-operative outcomes in paediatric cardiac surgery

Asif Padiyath,

Asif Padiyath

orcid.org/0000-0001-6817-6852

Division of Cardiothoracic Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Search for more papers by this author

Brian D. Lo,

Brian D. Lo

orcid.org/0000-0002-9389-3658

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Chin Siang Ong,

Chin Siang Ong

orcid.org/0000-0002-4521-0971

Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

Search for more papers by this author

Dheeraj Goswami,

Dheeraj Goswami

orcid.org/0000-0002-7538-4630

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Diana A. Steppan,

Diana A. Steppan

orcid.org/0000-0002-5580-2858

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Steven M. Frank,

Steven M. Frank

orcid.org/0000-0003-3533-3190

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Jochen Steppan,

Corresponding Author

Jochen Steppan

[email protected]

orcid.org/0000-0001-9856-512X

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Jochen Steppan, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 6208C, Baltimore, MD 21287, USA

Email: [email protected]

Search for more papers by this author

Asif Padiyath,

Asif Padiyath

orcid.org/0000-0001-6817-6852

Division of Cardiothoracic Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Search for more papers by this author

Brian D. Lo,

Brian D. Lo

orcid.org/0000-0002-9389-3658

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Chin Siang Ong,

Chin Siang Ong

orcid.org/0000-0002-4521-0971

Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

Search for more papers by this author

Dheeraj Goswami,

Dheeraj Goswami

orcid.org/0000-0002-7538-4630

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Diana A. Steppan,

Diana A. Steppan

orcid.org/0000-0002-5580-2858

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Steven M. Frank,

Steven M. Frank

orcid.org/0000-0003-3533-3190

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Search for more papers by this author

Jochen Steppan,

Corresponding Author

Jochen Steppan

[email protected]

orcid.org/0000-0001-9856-512X

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Jochen Steppan, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 6208C, Baltimore, MD 21287, USA

Email: [email protected]

Search for more papers by this author

First published: 24 March 2021

https://doi.org/10.1111/vox.13098

Share a link

Email
Wechat
Bluesky

Abstract

Background

Prior research on red blood cell (RBC) storage duration and clinical outcomes in paediatric cardiac surgery has shown conflicting results. The purpose of this study was to evaluate whether blood stored for a longer duration is harmful in these patients.

Methods

We performed a retrospective cohort study of paediatric patients undergoing cardiac surgery at our institution between January 2011 and June 2015. Patients were stratified based on whether they were transfused RBCs stored for ≤15 days (fresher blood) or >15 days (older blood). The primary outcome was composite morbidity, with prolonged length of stay (LOS) as a secondary outcome. Subgroup analyses were performed after stratification by RBC transfusion volume (≤2 vs. >2 RBC units). Multivariable logistic regression models were used to assess the impact of RBC storage duration on composite morbidity and prolonged LOS.

Results

Of 461 patients, 122 (26·5%) received fresher blood and 339 (73·5%) received older blood. The overall rate of composite morbidity was 18·0% (n = 22) for patients receiving fresher blood and 13·6% (n = 46) for patients receiving older blood (P = 0·24). In the risk-adjusted model, patients receiving older blood did not exhibit an increased risk of composite morbidity (OR: 0·74, 95% CI: 0·37–1·47, P = 0·40) or prolonged LOS (OR: 0·72, 95% CI: 0·38–1·35, P = 0·30) compared to patients receiving fresher blood. Similar results were seen after stratification by RBC transfusion volume.

Conclusions

Transfusing RBCs stored for a longer duration was not associated with an increased risk of morbidity or prolonged LOS in paediatric cardiac surgery patients.

Conflict of interests

S.M.F. participates on scientific advisory boards for Haemonetics, Medtronic and Baxter. All other authors declare no conflicts of interest.

References

1Medikonda R, Ong CS, Wadia R, et al. A review of goal-directed cardiopulmonary bypass management in pediatric cardiac surgery. World J Pediatr Congenit Hear Surg 2018; 9: 565–72.
10.1177/2150135118775964
PubMed Web of Science® Google Scholar
2Steiner ME, Ness PM, Assmann SF, et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med 2015; 372: 1419–29.
10.1056/NEJMoa1414219
CAS PubMed Web of Science® Google Scholar
3Manlhiot C, McCrindle BW, Menjak IB, et al. Longer blood storage is associated with suboptimal outcomes in high-risk pediatric cardiac surgery. Ann Thorac Surg 2012; 93: 1563–9.
10.1016/j.athoracsur.2011.08.075
PubMed Web of Science® Google Scholar
4Ranucci M, Carlucci C, Isgrò G, et al. Duration of red blood cell storage and outcomes in pediatric cardiac surgery: an association found for pump prime blood. Crit Care 2009; 13: R207.
10.1186/cc8217
PubMed Web of Science® Google Scholar
5Redlin M, Habazettl H, Schoenfeld H, et al. Red blood cell storage duration is associated with various clinical outcomes in pediatric cardiac surgery. Transfus Med Hemotherapy 2014; 41: 6.
10.1159/000357998
PubMed Web of Science® Google Scholar
6Cholette JM, Pietropaoli AP, Henrichs KF, et al. Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery. Pediatr Crit Care Med 2015; 16: 227–35.
10.1097/PCC.0000000000000320
PubMed Web of Science® Google Scholar
7Bishnoi AK, Garg P, Patel K, et al. Effect of prime blood storage duration on clinical outcome after pediatric cardiac surgery. World J Pediatr Congenit Hear Surg 2017; 8: 166–73.
10.1177/2150135116682451
PubMed Web of Science® Google Scholar
8Kawase H, Egi M, Kanazawa T, et al. Storage duration of transfused red blood cells is not significantly associated with postoperative adverse events in pediatric cardiac surgery patients. Transfus Apher Sci 2016; 54: 111–6.
10.1016/j.transci.2016.01.027
PubMed Web of Science® Google Scholar
9Baltsavias I, Faraoni D, Willems A, et al. Blood storage duration and morbidity and mortality in children undergoing cardiac surgery. Eur J Anaesthesiol 2014; 31: 310–6.
10.1097/EJA.0000000000000024
PubMed Web of Science® Google Scholar
10Bishnoi AK, Garg P, Patel K, et al. Effect of red blood cell storage duration on outcome after paediatric cardiac surgery: a prospective observational study. Hear Lung Circ 2019; 28: 784–91.
10.1016/j.hlc.2018.03.012
PubMed Web of Science® Google Scholar
11Frank SM, Resar LMS, Rothschild JA, Dackiw EA, Savage WJ, Ness PM. A novel method of data analysis for utilization of red blood cell transfusion. Transfusion 2013; 53: 3052–9.
10.1111/trf.12227
PubMed Web of Science® Google Scholar
12Johnson DJ, Scott AV, Barodka VM, et al. Morbidity and mortality after high-dose transfusion. Anesthesiology 2016; 124: 387–95.
10.1097/ALN.0000000000000945
CAS PubMed Web of Science® Google Scholar
13Jacobs JP, Jacobs ML, Maruszewski B, et al. Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardio-Thoracic Surg 2012; 42: 775–80.
10.1093/ejcts/ezs026
PubMed Web of Science® Google Scholar
14Jenkins KJ: Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–4.
10.1053/j.pcsu.2004.02.009
PubMed Google Scholar
15Lacroix J, Hébert PC, Fergusson DA, et al. Age of transfused blood in critically ill adults. N Engl J Med 2015; 372: 1410–8.
10.1056/NEJMoa1500704
CAS PubMed Web of Science® Google Scholar
16Heddle NM, Cook RJ, Arnold DM, et al. Effect of short-term vs. long-term blood storage on mortality after transfusion. N Engl J Med 2016; 375: 1937–45
10.1056/NEJMoa1609014
PubMed Web of Science® Google Scholar
17Fergusson DA, Hébert P, Hogan DL, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants. JAMA 2012; 308: 1443.
10.1001/2012.jama.11953
CAS PubMed Web of Science® Google Scholar
18Spinella PC, Tucci M, Fergusson DA, et al. Effect of fresh vs standard-issue red blood cell transfusions on multiple organ dysfunction syndrome in critically ill pediatric patients. JAMA 2019; 322: 2179.
10.1001/jama.2019.17478
PubMed Web of Science® Google Scholar
19Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, et al. Effect of transfusion of red blood cells with longer vs shorter storage duration on elevated blood lactate levels in children with severe anemia. JAMA 2015; 314: 2514.
10.1001/jama.2015.13977
CAS PubMed Web of Science® Google Scholar
20Frank SM, Abazyan B, Ono M, et al. Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration. Anesth Analg 2013; 116: 975–81.
10.1213/ANE.0b013e31828843e6
PubMed Web of Science® Google Scholar
21Scott AV, Nagababu E, Johnson DJ, et al. 2,3-Diphosphoglycerate concentrations in autologous salvaged versus stored red blood cells and in surgical patients after transfusion. Anesth Analg 2016; 122: 616–23.
10.1213/ANE.0000000000001071
CAS PubMed Web of Science® Google Scholar
22Lee AC, Reduque LL, Luban NLC, Ness PM, Anton B, Heitmiller ES. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion 2014; 54: 244–54.
10.1111/trf.12192
PubMed Web of Science® Google Scholar
23Bennett-Guerrero E, Veldman TH, Doctor A, et al. Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci 2007; 104: 17063–8.
10.1073/pnas.0708160104
CAS PubMed Web of Science® Google Scholar
24Hovav T, Yedgar S, Manny N, Barshtein G. Alteration of red cell aggregability and shape during blood storage. Transfusion 1999; 39: 277–81.
10.1046/j.1537-2995.1999.39399219284.x
CAS PubMed Web of Science® Google Scholar
25Gladwin MT, Kim-Shapiro DB: Storage lesion in banked blood due to hemolysis-dependent disruption of nitric oxide homeostasis. Curr Opin Hematol 2009; 16: 515–23.
10.1097/MOH.0b013e32833157f4
PubMed Web of Science® Google Scholar
26Roback JD, Neuman RB, Quyyumi A, Sutliff R. Insufficient nitric oxide bioavailability: A hypothesis to explain adverse effects of red blood cell transfusion. Transfusion 2011; 51: 859–66.
10.1111/j.1537-2995.2011.03094.x
CAS PubMed Web of Science® Google Scholar
27Iyengar A, Scipione CN, Sheth P, et al. Association of complications with blood transfusions in pediatric cardiac surgery patients. Ann Thorac Surg 2013; 96: 910–6.
10.1016/j.athoracsur.2013.05.003
PubMed Web of Science® Google Scholar
28Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–39.
10.1056/NEJMoa070403
CAS PubMed Web of Science® Google Scholar

Volume116, Issue9

October 2021

Pages 965-975

Red blood cell storage duration and peri-operative outcomes in paediatric cardiac surgery

Abstract

Background

Methods

Results

Conclusions

Conflict of interests

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Red blood cell storage duration and peri-operative outcomes in paediatric cardiac surgery

Abstract

Background

Methods

Results

Conclusions

Conflict of interests

References

References

Related

Information