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Red Blood Cell Transfusion After Stage I Palliation Is Associated With Worse Clinical Outcomes
Journal article   Open access   Peer reviewed

Red Blood Cell Transfusion After Stage I Palliation Is Associated With Worse Clinical Outcomes

Felina K Mille, Aditya Badheka, Priscilla Yu, Xuemei Zhang, David F Friedman, John Kheir, Sarah van den Bosch, Antonio G Cabrera, Javier J Lasa, Hannah Katcoff, …
Journal of the American Heart Association, Vol.9(10), pp.e015304-e015304
05/18/2020
DOI: 10.1161/JAHA.119.015304
PMCID: PMC7660859
PMID: 32390527
url
https://doi.org/10.1161/JAHA.119.015304View
Published (Version of record) Open Access

Abstract

Background Packed red blood cell transfusion may improve oxygen content in single-ventricle neonates, but its effect on clinical outcomes after Stage 1 palliation is unknown. Methods and Results Retrospective multicenter analysis of packed red blood cell transfusion exposures in neonates after Stage 1 palliation, excluding those with intraoperative mortality or need for extracorporeal membrane oxygenation. Transfusion practice variability was assessed, and multivariable regression used to identify transfusion risk factors. After propensity score adjustment for severity of illness, clinical outcomes were compared between transfused and nontransfused subjects. Of 396 subjects, 323 (82%) received 930 postoperative red blood cell transfusions. Packed red blood cell volume (median 9-42 mL/kg [ <0.0001]), donor exposures (1-2 [ <0.0001]), transfusion number (1-3 [ <0.0001]), and pretransfusion hemoglobin (12.1-13 g/dL, =0.0049) varied between sites. Cyanosis ( =0.02), chest tube output ( =0.0003), and delayed sternal closure ( =0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, =0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, =0.016). When stratified by number of transfusions (0, 1, or >1), duration of mechanical ventilation (3 [1, 5] versus 4 [3, 6] versus 9 [5, 16] days [ <0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [ <0.0001]) increased for those transfused more than once. Most subjects who died were transfused, though the association with mortality was not significant. Conclusions Packed red blood cell transfusion after Stage 1 palliation is common, and transfusion practice is variable. Transfusion is a significant predictor of longer intensive care unit stay and mechanical ventilation. Further studies to define evidence-based transfusion thresholds are warranted.
 Blalock-Taussig Procedure - adverse effects Blalock-Taussig Procedure - mortality Erythrocyte Transfusion - adverse effects Erythrocyte Transfusion - mortality Hospital Mortality Humans Infant, Newborn Intensive Care Units Length of Stay Norwood Procedures - adverse effects Norwood Procedures - mortality Palliative Care Respiration, Artificial Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome United States Univentricular Heart - mortality Univentricular Heart - physiopathology Univentricular Heart - surgery

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