Issue |
J Extra Corpor Technol
Volume 52, Number 2, June 2020
|
|
---|---|---|
Page(s) | 142 - 145 | |
DOI | https://doi.org/10.1051/ject/202052142 | |
Published online | 15 June 2020 |
Case Report
Bloodless Arterial Switch Operation in a 2.7-kg Jehovah’s Witness Patient
The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio; SUNY Upstate University, Syracuse, New York; and Department of Anesthesiology and Pain Management, Nationwide Children’s Hospital, Columbus, Ohio
Address correspondence to: Jeffrey L. Burnside, BS, CCP, FPP, The Heart Center at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. E-mail: Jeffrey.Burnside@NationwideChildrens.org
Received:
4
December
2019
Accepted:
30
March
2020
Bloodless pediatric cardiac surgery requiring the use of cardiopulmonary bypass (CPB) remains a challenge for the entire operating room (OR) team. The amount of circulating blood volume to pump prime volume mismatch of small patients results in hemodilution that frequently results in transfusion of allogeneic blood products. Patients of families of the Jehovah’s Witness (JW) faith reject the use of these products because of religious beliefs. Our institution is a referral center for children of JW families because we have developed techniques to minimize blood loss with the hope of performing bloodless pediatric cardiac surgery whenever possible. These techniques include preoperative treatment with erythropoietin, intraoperative acute normovolemic hemodilution, CPB circuit miniaturization, ultrafiltration during and after CPB, limiting blood gas analyses or other unnecessary blood draws, and using hemostatic agents during and after CPB. We present the case of a 4-day-old patient of the JW faith weighing 2.7 kg with transposition of the great arteries and an intact ventricular septum who underwent an arterial switch operation. The patient received no allogeneic blood product administration throughout the entire hospitalization. The patient’s first hematocrit in the OR was 43%, lowest hematocrit on bypass was 15%, and first hematocrit in the cardiothoracic intensive care unit post-procedure was 21%. The patient was discharged on post-op day nine with a hematocrit of 36%.
Key words: pediatric cardiac surgery / Jehovah’s witness / arterial switch operation / bloodless surgery / neonatal
© 2020 AMSECT
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