Risk Factors for Red Blood Cell Transfusions in Children Undergoing Cardiac Catheterizations

Ligon, Allen

Risk Factors for Red Blood Cell Transfusions in Children Undergoing Cardiac Catheterizations

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Allen Ligon, M.D. , Children's Healthcare of Atlanta / Emory University, Atlanta, GA

David L Gruenewald, MS , Children's Healthcare of Atlanta / Emory University, Atlanta, GA

Laura A Downey, MD , Children's Healthcare of Atlanta / Emory University, Atlanta, GA

Holly Bauser-Heaton, M.D., Ph.D., FSCAI , Sibley Heart Center of Children's Healthcare of Atlanta, Atlanta, GA

Dennis W. Kim, M.D., Ph.D., FSCAI , Children's Healthcare of Atlanta, Atlanta, GA

Meredith F Roman, NP , Children's Healthcare of Atlanta / Emory University, Atlanta, GA

Robert N. Vincent, M.D., MSCAI , Sibley Heart Center, Atlanta, GA

Christopher J. Petit, M.D. , Emory University, Atlanta, GA

Background
There is limited data regarding risk factors for red blood cell transfusion (RBCT) in children following cardiac catheterizations (CC). The purpose of our study was to identify patient and procedural-specific factors associated with risk of RBCT during CC.

Methods
We performed a review of all CC between 2012-17. The primary endpoint was RBCT within 72h of CC. Patient and procedure-specific factors were assessed. Generalized linear modelling was performed.

Results
During the study period, 831 RBCT occurred among 6028 unique CC - most occurring during (n=148) or within 6 hours (n=394) of CC. Univariate analysis revealed that RBCT patients were younger (79 vs 2068 days, p<0.01) and of lower weight (4.23kg vs 19.1kg, p<0.01). Risk of RBCT was highest among infants (37.6% vs 13.8% in entire cohort). In infants, estimated blood loss /calculated circulating blood volume (EBL/cCBV) was greater in the RBCT cohort (2.9% vs 1.2%; p=0.03). In infants, weight (OR 0.72; CI 0.63-0.81), complex 2-ventricle (OR 3.14, CI 2.18-4.57) and single ventricle (SV) status (OR 5.21, CI 3.42-8.01) were associated with RBCT. Infants from intensive care (OR 4.74; CI 3.49-6.49) or stepdown units (OR 2.33; CI 1.58-3.46) were at higher risk. Procedure time (OR 2.57; CI 2.03-3.26) and oxygen saturation (OR 0.98; CI 0.97-0.99) were also associated with RBCT (Figure 1A & 1B).

Conclusions
RBCT occurs in a significant proportion of CC - rising to a rate of 37.6% in infants. Infants with complex anatomy are at highest risk of RBCT. Procedure time, EBL/cCBV and oxygen saturations are important risk factors. Operators should consider these factors when planning CC.