• Aymen N Naguib, Peter D Winch, Joseph D Tobias, Janet Simsic, Diane Hersey, Kathleen Nicol, Thomas Preston, Daniel Gomez, Patrick McConnell, and Mark Galantowicz.
• Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
• Paediatr Anaesth. 2015 May 1;25(5):477-86.

BackgroundThe transfusion of blood products in the setting of uncontrolled bleeding is unquestionably lifesaving. However, in many instances, the decision to transfuse is based on physician gestalt rather than medical evidence. When indications for transfusion are unclear, the benefits of blood products must be balanced against their significant risks and associated costs. As our institution is a referral center for patients of Jehovah's Witness faith, this population has pushed our development of techniques to achieve the goal of bloodless surgery. Our practices in caring for this population have become our standard practice for managing all patients undergoing congenital cardiac surgery.ObjectivesTo evaluate our success in minimizing the use of blood products during pediatric cardiac surgery.MethodsAfter IRB approval, we retrospectively reviewed all patients who underwent cardiac surgery utilizing cardiopulmonary bypass (CPB), for biventricular repair procedures. The study was conducted at a single institution (Nationwide Children's Hospital (NCH)) during the period: January 1, 2013 and December 31, 2013.ResultsA total of 209 patients were included. Overall, 81 patients (38.8%) and 81 of 136 (59.6%) weighing more than 6 kg received no blood products (bloodless) during their entire hospital stay. Bloodless surgery was most successful in patients weighing more than 18 kg, followed by patients weighing 6-18 kg. All 73 patients who weighed <6 kg received blood transfusion during their hospitalization.ConclusionThe techniques that we have developed to initially care for our Jehovah's Witness families may be applied to other pediatric and adult surgical procedures.© 2015 John Wiley & Sons Ltd.

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