Patient blood management in pediatric cardiovascular surgery patients during the COVID-19 pandemic: Is it applicable?

Aim: To limit the spread of coronavirus disease (COVID-19), social isolation and reduced mobility have been recommended. However, this has led to the rapid depletion of blood stocks as people are afraid of catching the highly contagious disease. This study aimed to present blood management practices in pediatric cardiovascular surgery patients during the pandemic and the relationship between blood products and patient outcomes such as pediatric intensive care unit (PICU) stay and mortality.

Material and Methods: In this retrospective cohort study, we compared 201 patients who underwent pediatric cardiovascular surgery during the COVID-19 pandemic (11.03.2020-30.11.2020, pandemic group) with 206 patients operated during the same period in 2019 (pre-pandemic control group). We used R (version 4.2.2; R Core Team, R Foundation for Statistical Computing, Vienna, Austria) for statistical analysis. Continuous variables were presented as median and interquartile range or mean SD. Logistic regression predicted blood and blood product usage based on pre and postoperative time. Multivariable logistic regression was conducted with a p-value less than 0.10 for predicting mortality.

Results: In 2019 and 2020, 56% of patients who underwent surgery were male. The median age was 19.5 (5.4-92.6) months in 2019 and 10.3 (4.6-7.1) months in 2020, with a significant difference (p-value of 0.01). The RACHS score was higher in 2019 than 2020 (p-value < 0.001), and a similar percentage of patients required extracorporeal membrane oxygenation (ECMO) support in both years.

Conclusion: We continued to use patient blood management, which we started to use in the past as well. Patient Blood Management guidelines should be tailored to each centre to ensure optimal patient care based on needs and centre dynamics. Allogeneic transfusions pose a risk-benefit balance, and limited transfusions can benefit patients more significantly.