Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants

Steven S. Mou, Brett P. Giroir, Erica A. Molitor-Kirsch, Steven R. Leonard, Hisashi Nikaidoh, Frank Nizzi, Deborah A. Town, Lonnie C. Roy, William Scott, Daniel Stromberg

Research output: Contribution to journalArticle

134 Scopus citations

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 peri-operative fluid overload.

Original languageEnglish (US)
Pages (from-to)1635-1644
Number of pages10
JournalNew England Journal of Medicine
Volume351
Issue number16
DOIs
StatePublished - Oct 14 2004

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants'. Together they form a unique fingerprint.

  • Cite this

    Mou, S. S., Giroir, B. P., Molitor-Kirsch, E. A., Leonard, S. R., Nikaidoh, H., Nizzi, F., Town, D. A., Roy, L. C., Scott, W., & Stromberg, D. (2004). Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants. New England Journal of Medicine, 351(16), 1635-1644. https://doi.org/10.1056/NEJMoa041065