Transfusion in Pediatric Cardiac Surgery: A Moving Target : Anesthesia & Analgesia

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Transfusion in Pediatric Cardiac Surgery: A Moving Target

Nathan, Naveen MD; Nalubola, Shreya; Weber, Garret MD

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doi: 10.1213/ANE.0000000000005771
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The relationship between hematocrit and postoperative mortality is complex. In the setting of pediatric cardiac surgery, the influences of hemodilution, thrombodilution, systemic inflammatory response, and intrinsic disease states superimpose themselves on this seemingly unanswerable question. This issue of Anesthesia & Analgesia offers a retrospective, cross-sectional analysis of >27,000 index operations in the pediatric cardiac surgery setting. The investigators were able to demonstrate that mortality and major complications increased as the postoperative hematocrit >38% and >42% in acyanotic and cyanotic patients, respectively. The accompanying editorial by Faraoni and DiNardo places their findings within a broader context of whether outcomes reflect hematocrit per se, or rather derive from the acuity and critical illness of patients for which transfusion is indicated. The reader is strongly encouraged to review both the primary investigation, as well as its attendant editorial for a comprehensive depth of understanding of this complex question.

    REFERENCES

    1. Long JB, Engorn BM, Hill KD, et al. Postoperative hematocrit and adverse outcomes in pediatric cardiac surgery patients: a cross-sectional study from the STS and CCAS database collaboration. Anesth Analg. 2021;133:1077–1088.
    2. Faraoni D, DiNardo JA. Red blood cell transfusion and adverse outcomes in pediatric cardiac surgery patients: where does the blame lie? Anesth Analg. 2021;133:1074–1076.
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