(131) Bleeding Before and After Pediatric Cardiopulmonary Bypass Primed With Leukoreduced Whole Blood

Introduction: Children with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) are at an elevated risk of mortality from bleeding complications. Earlier studies conflict if priming the CPB circuit with fresh whole blood (WB) or stored components of packed erythrocytes (PRBC) and plasma (FFP) reduces bleeding. Recently, leukoreduced whole blood (LRWB) using Imuflex® blood bags have improved outcomes in pediatric trauma mass causality incidents. We hypothesize that transfusion rates decrease in children who underwent CPB primed with LRWB versus components.

Methods: This is a single-center, retrospective cohort analysis of children who underwent CPB primed with either LRWB (38 patients) or components (41 patients). Primary endpoints were perioperative transfusions administered, chest tube output, and unplanned operations for bleeding control during the first postoperative day. Results of coagulation assays, degree of vasoactive and respiratory support, and volumes of autologous blood and colloid administered in the postoperative period were compared. Levene’s test compared homogeneity, Welch’s test compared continuous data, and Fisher’s exact test compared categorical variables.

Results: The groups were not significantly different with respect to patient age, weight, surgical complexity, CPB time, myocardial ischemia time, and primary surgeon. The LRWB group received significantly less intraoperative blood transfusion volume (mean 73 vs 108 mL/kg, p = 0.039) and higher postoperative PTT (mean 37 vs 34 seconds, p = 0.007) compared to the component primed group. There was no significant difference in postoperative transfusion volume (mean 6.7 vs 2.3 mL/kg, p = 0.317), average chest tube output in the first four postoperative hours (mean 2.6 vs 2.3 mL/kg, p = 0.443), or rates of unplanned procedures to address bleeding (11% vs 15%, OR 0.686, CI 0.18-2.65, p = 0.739) between the LRWB and component groups.

Conclusions: Children with CHD who underwent CPB primed with LRWB versus stored components of PRBC and FFP required significantly less intraoperative blood. Although not statistically significant, fewer unplanned procedures to mitigate bleeding were observed in the LRWB group. A prospective, multi-center study is needed to determine if LRWB CPB prime improves clinical outcomes in CHD patients.