Pump Priming in Heart Surgery in Infants
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《新英格兰医药杂志》
To the Editor: Mou and associates (Oct. 14 issue)1 report that the use of fresh whole blood for pump priming in cardiopulmonary bypass surgery in infants had no advantage over the use of reconstituted whole blood (a combination of red cells and fresh-frozen plasma). Indeed, priming with fresh whole blood was associated with an increased time in the intensive care unit and fluid overload. Since products from two donors were required to prepare reconstituted whole blood, the use of fresh whole blood reduced donor exposure. The authors suggest the extra exposure associated with reconstituted whole blood could be eliminated with the use of products from a single donor.
In a feasibility study involving a community blood center and a children's hospital, we demonstrated that it is logistically possible to provide matching units of red cells and fresh-frozen plasma from the same donor.2 Over a three-month period, we saved 132 exposures for 106 patients, including, but not limited to, patients undergoing cardiopulmonary bypass surgery. This program is ongoing. During the first six months of 2004, 81 of 83 open-heart operations with a primed cardiopulmonary pump in infants were carried out with red cells and fresh-frozen plasma from a single donor; the total additional cost for the fresh-frozen plasma was $2,884. In the cases in which the red cells and the fresh-frozen plasma were not from a single donor, the patients' blood type was AB and the fresh-frozen plasma was not compatible.
Marilyn S. Hamilton, M.D., Ph.D.
Children's Mercy Hospital
Kansas City, MO 64108
mhamilton@cmh.edu
Jay E. Menitove, M.D.
Community Blood Center of Greater Kansas City
Kansas City, MO 64111
In a feasibility study involving a community blood center and a children's hospital, we demonstrated that it is logistically possible to provide matching units of red cells and fresh-frozen plasma from the same donor.2 Over a three-month period, we saved 132 exposures for 106 patients, including, but not limited to, patients undergoing cardiopulmonary bypass surgery. This program is ongoing. During the first six months of 2004, 81 of 83 open-heart operations with a primed cardiopulmonary pump in infants were carried out with red cells and fresh-frozen plasma from a single donor; the total additional cost for the fresh-frozen plasma was $2,884. In the cases in which the red cells and the fresh-frozen plasma were not from a single donor, the patients' blood type was AB and the fresh-frozen plasma was not compatible.
Marilyn S. Hamilton, M.D., Ph.D.
Children's Mercy Hospital
Kansas City, MO 64108
mhamilton@cmh.edu
Jay E. Menitove, M.D.
Community Blood Center of Greater Kansas City
Kansas City, MO 64111