Skip to main content
Journal cover image

Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.

Publication ,  Journal Article
Machovec, KA; Jooste, EH
Published in: J Cardiothorac Vasc Anesth
July 2019

Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of blood transfusions have been associated with increased morbidity in pediatric cardiac patients. Transfusion of red blood cells, platelets, and coagulation factors is necessary to combat the hemodilution associated with cardiopulmonary bypass and to treat postoperative bleeding. We are challenged to apply new pharmacologic, extracorporeal, and laboratory testing advances in an evidence-based, systemic fashion to allow for appropriate transfusion. Transfusion algorithms may aid in this process, but current evidence for efficacy of transfusion algorithms in this population is limited to single-center studies. Development of a transfusion algorithm for the pediatric cardiac population requires individualization at both the institutional level, considering local resources, equipment, and case mix, and the patient level, considering age, cardiac diagnosis, and planned procedure, at minimum. A growing body of literature suggests that application of appropriate intraoperative testing (platelet count, fibrinogen concentration, thromboelastometry) along with recognition of risk factors for bleeding, adequate bypass anticoagulation, and judicious use of factor concentrates allows for thoughtful transfusion and potentially improved outcomes in pediatric cardiac patients. This review examines the evolution of transfusion algorithms in pediatric cardiac surgery and examines the considerations involved in building an algorithm for this challenging, heterogenous population.

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

July 2019

Volume

33

Issue

7

Start / End Page

2017 / 2029

Location

United States

Related Subject Headings

  • Postoperative Hemorrhage
  • Operating Rooms
  • Humans
  • Child
  • Cardiac Surgical Procedures
  • Blood Transfusion
  • Blood Coagulation
  • Anesthesiology
  • Algorithms
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Machovec, K. A., & Jooste, E. H. (2019). Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You. J Cardiothorac Vasc Anesth, 33(7), 2017–2029. https://doi.org/10.1053/j.jvca.2018.12.008
Machovec, Kelly A., and Edmund H. Jooste. “Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.J Cardiothorac Vasc Anesth 33, no. 7 (July 2019): 2017–29. https://doi.org/10.1053/j.jvca.2018.12.008.
Machovec KA, Jooste EH. Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You. J Cardiothorac Vasc Anesth. 2019 Jul;33(7):2017–29.
Machovec, Kelly A., and Edmund H. Jooste. “Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.J Cardiothorac Vasc Anesth, vol. 33, no. 7, July 2019, pp. 2017–29. Pubmed, doi:10.1053/j.jvca.2018.12.008.
Machovec KA, Jooste EH. Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You. J Cardiothorac Vasc Anesth. 2019 Jul;33(7):2017–2029.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

July 2019

Volume

33

Issue

7

Start / End Page

2017 / 2029

Location

United States

Related Subject Headings

  • Postoperative Hemorrhage
  • Operating Rooms
  • Humans
  • Child
  • Cardiac Surgical Procedures
  • Blood Transfusion
  • Blood Coagulation
  • Anesthesiology
  • Algorithms
  • 3201 Cardiovascular medicine and haematology