TY - JOUR
T1 - Red blood cell transfusion after stage I palliation is associated with worse clinical outcomes
AU - Mille, Felina K.
AU - Badheka, Aditya
AU - Yu, Priscilla
AU - Zhang, Xuemei
AU - Friedman, David F.
AU - Kheir, John
AU - van den Bosch, Sarah
AU - Cabrera, Antonio G.
AU - Lasa, Javier J.
AU - Katcoff, Hannah
AU - Hu, Paula
AU - Borasino, Santiago
AU - Hock, Krissie
AU - Huskey, Jordan
AU - Weller, Jamie
AU - Kothari, Harsh
AU - Blinder, Joshua
N1 - Funding Information:
This work was supported in part by The Cardiac Center Research Core at The Children’s Hospital of Philadelphia.
Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020
Y1 - 2020
N2 - 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 [P<0.0001]), donor exposures (1–2 [P<0.0001]), transfusion number (1–3 [P<0.0001]), and pretransfusion hemoglobin (12.1–13 g/dL, P=0.0049) varied between sites. Cyanosis (P=0.02), chest tube output (P=0.0003), and delayed sternal closure (P=0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, P=0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, P=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 [P<0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [P<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.
AB - 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 [P<0.0001]), donor exposures (1–2 [P<0.0001]), transfusion number (1–3 [P<0.0001]), and pretransfusion hemoglobin (12.1–13 g/dL, P=0.0049) varied between sites. Cyanosis (P=0.02), chest tube output (P=0.0003), and delayed sternal closure (P=0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, P=0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, P=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 [P<0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [P<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.
KW - Congenital heart disease
KW - Neonates
KW - Norwood operation
KW - Red blood cell transfusion
KW - Single ventricle
KW - Stage I palliation
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U2 - 10.1161/JAHA.119.015304
DO - 10.1161/JAHA.119.015304
M3 - Article
C2 - 32390527
AN - SCOPUS:85084941475
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 10
M1 - e015304
ER -