Background

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) carries substantial transfusion requirements, exposing patients to increased risks of complications during hospital stay. This study evaluates the clinical impact of a quality-controlled, multimodal blood conservation strategy during CPB in pediatric cardiac surgery.

Methods

We collected the medical data of 9792 children (aged ≤ 14 years and weight > 10 kg) undergoing CPB cardiac surgery between September 2014 and December 2021. Since January 2016, the pediatric CPB center has implemented patient blood management. Subsequently, patients were divided into two groups: conventional management group (premanagement, n = 1762) and patient blood management group (postmanagement, n = 8030). Compare blood transfusion and outcomes. A 1:1 propensity score matching was performed.

Results

1760 matched patient pairs were obtained. Compared with the premanagement group, the postmanagement group demonstrated significant reduction in packed red blood cell (PRBC) transfusion rates (during hospital stay: 38.1% vs. 33.6%, p = 0.007; CPB: 18.2% vs. 11.1%, p < 0.001), lower plasma transfusion rates (20.7% vs. 16.6%, p = 0.002), furthermore, decreased CPB priming volume (29.2 vs. 29.1 mL/kg, p = 0.042), lower incidence of postoperative liver injury (15.7% vs. 10.5%, p < 0.001) and AKI (7.5% vs. 5.5%, p = 0.017).

Conclusions

Following the postmanagement, comprehensive blood conservation strategies significantly reduce transfusion requirements and improve clinical outcomes for this vulnerable population, establishing an effective framework for blood resource utilization and safety during hospital stay.