Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery

Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution. This retrospective observational study included 148 consecutive infants between 1 and 12 months of age, with a body weight <10 kg, who underwent an elective cardiac operation between 1997 and 2005. Patients were divided into three groups defined by the circuit prime volume; 700 ml (Group 1), 450 ml (Group 2) and 330 ml (Group 3). In Group 1 residual volume after perfusion was discarded and in Groups 2 and 3 was processed in a cell saving device. Analyzed variables were: perioperative blood loss, transfusion of homologous blood products and cell salvage product, and hematology data. Reduction of the circuit volume significantly diminished use of red blood cell concentrates from 1.6 units to 0.8 units (P<0.0001), and fresh frozen plasma from 1.3 units to 0.4 units (P<0.0001). Utilization of the cell salvage product reduced significantly (P=0.023) the postoperative need for homologous blood transfusion. Therefore, both measures proved to be effective in reducing homologous blood transfusion in infant cardiac surgery.