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Red cell transfusion practices after stage 1 palliation: a survey of practitioners from the Pediatric Cardiac Intensive Care Society

Published online by Cambridge University Press:  14 November 2019

Aditya Badheka Open the ORCID record for Aditya Badheka [Opens in a new window] ,
Priscilla Yu ,
Felina Mille ,
Dennis Durbin ,
Okan Elci  and
Joshua Blinder
Aditya Badheka*
Affiliation:
Division of Critical Care, Department of Pediatrics, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA, USA
Priscilla Yu
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
Felina Mille
Affiliation:
Division of Cardiac Critical Care, Department of Anesthesia/Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Dennis Durbin
Affiliation:
Department of Pediatrics and the Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
Okan Elci
Affiliation:
Westat, Rockville, MD, USA Biostatistics and Data Management Core, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Joshua Blinder
Affiliation:
Division of Cardiac Critical Care, Department of Anesthesia/Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: Aditya Badheka, MD MS, Assistant Clinical Professor, Division of Pediatric Critical Care, Department of Pediatrics, 200 Hawkins Dr., Iowa City, IA 52242, USA. Tel: +1 319 356 1615; Fax: +1 319 356 8443; E-mail: aditya-badheka@uiowa.edu
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Abstract

Introduction:

Neonates may require increased red cell mass to optimise oxygen content after stage 1 palliation; however, data informing transfusion practices are limited. We hypothesise there is a patient-, provider-, and institution-based heterogeneity in red cell transfusion decision-making after stage 1 palliation.

Methods:

We conducted an online survey of Pediatric Cardiac Intensive Care Society practitioners in 2016. Respondents answered scenario-based questions that defined transfusion indications and identified haematocrit transfusion thresholds. Respondents were divided into restrictive and liberal groups based on a haematocrit score. Fisher’s exact test was used to determine the associations between transfusion likelihood and patient, provider, and institutional characteristics. Bonferroni correction was applied to adjust the p-value to 0.004 for multiple comparisons.

Results:

There was a 21% response rate (116 responses). Most were male (58.6%), attending physicians (85.3%) with >5 year of intensive care experience (88.7%) and subspeciality training in critical care medicine (47.4%). The majority of institutions were academic (96.6%), with a separate cardiac ICU (86.2%), and performed >10 stage 1 palliation cases annually (68.1%). After Bonferroni correction, there were no significant patient, respondent, or institutional differences between the restrictive and liberal groups. No respondent or institutional characteristics influenced transfusion decision-making after stage 1 palliation.

Conclusions:

Decision-making around red cell transfusion after stage 1 palliation is heterogeneous. We found no clear relationships between patient, respondent, or institutional characteristics and transfusion decision-making among surveyed respondents. Given the lack of existing data informing red cell transfusion after stage 1 palliation, further studies are necessary to inform evidence-based guidelines.

Keywords

Single ventricle palliationred cell transfusionsurveypost-operative
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1452 - 1458
Copyright
© Cambridge University Press 2019 

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