de Gast-Bakker et al. undertook a randomized controlled trial to compare the outcome of children allocated to receive a red blood cell (RBC) transfusion if their hemoglobin level (Hb) dropped below 8 g/dL (restrictive group) or below 10.8 g/dL (liberal group). All children with a planned cardiac surgery were considered for inclusion if they were older than 6 weeks. Patients with a cyanotic cardiac condition were excluded. Patients were randomized before surgery, and the research protocol with respect to RBC transfusion was initiated in the operating room and maintained up to PICU discharge.

One hundred patients were enrolled and retained for analysis. The volume of RBC given was lower in the restrictive group than in the liberal group (159 ± 71 vs. 265 ± 80 mL/patient; P < 0.001). Duration of mechanical ventilation, length of PICU stay and incidence of adverse events were similar in both groups, but length of hospital stay tended to be shorter in the restrictive group (median: 8 {IQR: 7-11} versus 9 {7-14}; P = 0.063). Costs of blood products were 158 vs. 339 Euros per patient. The authors conclude: “For patients with non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8 mg/dL) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive”.

– Jacques Lacroix