To evaluate the effect of a blood conservation program on trends in use of donor blood products and early clinical outcomes in infants undergoing open heart surgery.

Four hundred nine patients younger than age 1 year undergoing open-heart surgery between October 1, 2020, and June 30, 2023, were reviewed. The study period was divided into 4 eras with the first era as a before blood conservation baseline using traditional blood management. The following 3 eras comprised incremental implementation and evolution of blood conservation strategies. The total volume of blood products transfused for each surgical hospitalization was calculated and indexed to body weight at time of surgery.

There was no significant difference in age at surgery, body weight, distribution of The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery categories, and in postoperative length of mechanical ventilation, intensive care unit or hospital length of stay, or postoperative mortality (P > .05 for all) across the 4 eras. Median total volume of blood products administered during hospitalization decreased from 128 mL/kg (range, 92-220 mL/kg) during the baseline period to 21 mL/kg (range, 6-44 mL/kg) during the last era (P < .01). Multivariate analysis demonstrated that later eras were associated with decreased odds of experiencing exposure to blood products during hospitalization.

Blood conservation is associated with significant reduction in usage of blood products during open heart surgery in infants with no significant effect on early outcomes. This trend is observed across all categories of surgical complexity. Additional studies are needed to prove consistency and to determine the longer-term clinical impact of this strategy.