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Previous Volume 351:1635-1644 October 14, 2004 Number 16 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Edmunds, L. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In an attempt to reduce the coagulopathic and inflammatory responses seen after cardiopulmonary bypass, the use of fresh whole blood during heart operations has become the standard of care for neonates and infants at many institutions. We compared the use of fresh whole blood with the use of a combination of packed red cells and fresh-frozen plasma (reconstituted blood) for priming of the cardiopulmonary bypass circuit.

Methods We conducted a single-center, randomized, double-blind, controlled trial involving children less than one year of age who underwent open-heart surgery. Patients were assigned to receive either fresh whole blood that had been collected not more than 48 hours previously (96 patients) or reconstituted blood (104 patients) for bypass-circuit priming. Clinical outcomes and serologic measures of systemic inflammation and myocardial injury were compared between the groups.

Results The group that received reconstituted blood had a shorter stay in the intensive care unit than the group that received fresh whole blood (70.5 hours vs. 97.0 hours, P=0.04). The group that received reconstituted blood also had a smaller cumulative fluid balance at 48 hours (–6.9 ml per kilogram of body weight vs. 28.8 ml per kilogram, P=0.003). Early postoperative chest-tube output, blood-product transfusion requirements, and levels of serum mediators of inflammation and cardiac troponin I were similar in the two groups.

Conclusions The use of fresh whole blood for cardiopulmonary bypass priming has no advantage over the use of a combination of packed red cells and fresh-frozen plasma during surgery for congenital heart disease. Moreover, circuit priming with fresh whole blood is associated with an increased length of stay in the intensive care unit and increased perioperative fluid overload.

Source Information

From the Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center (S.S.M., B.P.G., E.A.M.-K., S.R.L., H.N., D.A.T., L.C.R., W.S., D.S.); and Carter BloodCare (F.N.) — both in Dallas.

Address reprint requests to Dr. Stromberg at the Division of Cardiology, Children's Medical Center, 1935 Motor St., Dallas, TX 75235, or at daniel.stromberg{at}childrens.com.

Full Text of this Article

Related Letters:

Pump Priming in Heart Surgery in Infants
Hamilton M. S., Menitove J. E.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:731, Feb 17, 2005. Correspondence

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