• Yves Durandy.
• Intensive Care and Perfusion Department, Institut Hospitalier Jacques Cartier, Massy, France. iciprea@icip.org
• ASAIO J. 2009 Jan 1;55(1):117-20.

AbstractAlthough blood transfusion is essential in pediatric surgery, it is associated with increased morbidity. The goal of this study is to assess the efficiency of downsized bypass circuits and vacuum-assisted venous return in decreasing the need for blood transfusion. This study was performed on 150 patients weighing 2.3-10 kg. The bypass circuit was composed of a Kids D100 oxygenator and 3/16 in. lines, with a 120-ml prime volume. The objective was to maintain a hemoglobin level of at least 8 g/dl during the procedure. Venous drainage was both gravity-dependent and vacuum-assisted. The level and tolerance of hemodilution were estimated based on hemoglobin and serum lactate dosages and on the time to extubation. Venous drainage varied from 500 to 1200 ml/min. All patients weighing <6.4 kg were transfused and 55% of the patients weighing 6.4-10 kg had bloodless surgery, none had platelet infusion. In bloodless surgery, the median hemoglobin level was 11.4 g/dl before surgery, 8.7 g/dl during bypass, and 10.6 g/dl postoperatively, median serum lactate levels were always under 2 mmol/L and the median time to extubation was 3 hours. Compared to gravity-dependent venous drainage, vacuum-assisted venous return is efficient for further reducing allogeneic blood transfusion.

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