Intraoperative blood product transfusion in pediatric cardiac surgery patients: a retrospective review of adverse outcomes

Document Type

Journal Article

Publication Date



Paediatric anaesthesia




anesthesia; blood; cardiac; pediatric; surgery; transfusion


BACKGROUND: Resuscitation with blood products is often required for pediatric cardiac surgery patients following cardiopulmonary bypass. However, data suggests that blood product transfusion is an independent predictor of adverse outcomes. Most studies have specifically found detrimental effects of overall transfusion of red blood cells in particular, but few have analyzed outcomes by the other specific blood product components. AIMS: The objective of this study is to analyze adverse outcomes associated with intraoperative transfusion of specific blood product components. METHODS: A retrospective review was performed on 643 pediatric patients who underwent cardiac surgery requiring cardiopulmonary bypass to evaluate the risk of selected adverse outcomes associated with intraoperative blood product transfusion. Adverse outcomes included thrombotic complications, stroke, acute kidney injury, prolonged mechanical ventilation, and death. Univariate logistic and linear regression analyses were performed to explore the association between various blood products and the occurrence of postoperative complications. Multiple logistic and linear regression analyses were performed adjusting for age, cyanotic status, STAT score, and cardiopulmonary bypass time. RESULTS: Unadjusted analysis using univariate logistic and linear regressions showed statistically significant associations of almost all blood components (per 10 ml/kg dose increments) with multiple postoperative complications, including mortality, thrombotic complications, stroke, and days of mechanical ventilation. After adjusting for patient age, cyanotic status, STAT score, and CPB time, multivariable logistic and linear regression analyses revealed no association between transfusion of blood products with acute kidney injury and stroke. Administration of RBCs was the only category significantly correlated with increased days of mechanical ventilation (0.5 days increase of mechanical ventilation per 10 ml/kg transfusion of RBCs). The only blood product to show complete lack of a statistically significant association with any of the studied outcomes was cryoprecipitate. CONCLUSIONS: Transfusion of blood products following cardiopulmonary bypass is associated with postoperative adverse outcomes. Future studies aimed at strategies to reduce intraoperative bleeding and decrease the amount of blood products administered are warranted.


Anesthesiology and Critical Care Medicine