Effect of red blood cell storage time in pediatric cardiac surgery patients: A subgroup analysis of a randomized controlled trialCentral MessagePerspective
Sophie M. Martin, MD,
Marisa Tucci, MD,
Philip C. Spinella, MD,
Thierry Ducruet, MSc,
Dean A. Fergusson, MHA, PhD,
Darren H. Freed, MD, PhD,
Jacques Lacroix, MD,
Nancy Poirier, MD,
Venkatesan B. Sivarajan, MD, MS,
Marie E. Steiner, MD, MS,
Ariane Willems, MD, PhD,
Gonzalo Garcia Guerra, MD, PhD, MSc
Affiliations
Sophie M. Martin, MD
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
Marisa Tucci, MD
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
Philip C. Spinella, MD
Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
Thierry Ducruet, MSc
Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
Dean A. Fergusson, MHA, PhD
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Darren H. Freed, MD, PhD
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
Jacques Lacroix, MD
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
Nancy Poirier, MD
Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
Venkatesan B. Sivarajan, MD, MS
Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
Marie E. Steiner, MD, MS
Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
Ariane Willems, MD, PhD
Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
Gonzalo Garcia Guerra, MD, PhD, MSc
Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada; Address for reprints: Gonzalo Garcia Guerra, MD, PhD, MSc, Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, 28 Oki Dr, NW, T3B6A8, Calgary, Alberta, T6G1C9, Canada.
Objective: This study aimed to determine whether or not transfusion of fresh red blood cells (RBCs) reduced the incidence of new or progressive multiple organ dysfunction syndrome compared with standard-issue RBCs in pediatric patients undergoing cardiac surgery. Methods: Preplanned secondary analysis of the Age of Blood in Children in Pediatric Intensive Care Unit study, an international randomized controlled trial. This study included children enrolled in the Age of Blood in Children in Pediatric Intensive Care Unit trial and admitted to a pediatric intensive care unit after cardiac surgery with cardiopulmonary bypass. Patients were randomized to receive either fresh (stored ≤7 days) or standard-issue RBCs. The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured up to 28 days postrandomization or at pediatric intensive care unit discharge, or death. Results: One hundred seventy-eight patients (median age, 0.6 years; interquartile range, 0.3-2.6 years) were included with 89 patients randomized to the fresh RBCs group (median length of storage, 5 days; interquartile range, 4-6 days) and 89 to the standard-issue RBCs group (median length of storage, 18 days; interquartile range, 13-22 days). There were no statistically significant differences in new or progressive multiple organ dysfunction syndrome between fresh (43 out of 89 [48.3%]) and standard-issue RBCs groups (38 out of 88 [43.2%]), with a relative risk of 1.12 (95% CI, 0.81 to 1.54; P = .49) and an unadjusted absolute risk difference of 5.1% (95% CI, −9.5% to 19.8%; P = .49). Conclusions: In neonates and children undergoing cardiac surgery with cardiopulmonary bypass, the use of fresh RBCs did not reduce the incidence of new or progressive multiple organ dysfunction syndrome compared with the standard-issue RBCs. A larger trial is needed to confirm these results.
