The indication for perioperative red blood cell transfusions is a predictive risk factor for severe postoperative morbidity and mortality in children undergoing cardiac surgery.

Willems et al. completed a retrospective single center study on 193 consecutive cases of paediatric cardiac surgery. The authors compared the outcomes of 92 patients who received red blood cell transfusion (RBCT) only during cardiopulmonary bypass (CPB) and 100 who received RBCT in the intensive care unit after the surgery. The hypothesis was that indication for RBCT (anaemia, severity of illness, etc.) will be a better predictor of worse outcomes than RBCT by themselves. Anaemia was not associated with worse outcomes while indication for post-operative RBCT was, even after adjustment for many significant predictors of RBCT. The authors conclude that indication for postoperative RBCT “has an impact on the occurrence of severe postoperative morbidity and mortality in children undergoing cardiac surgery”.

The results of this investigation are important: they suggest that RBCT per se may be less significant predictors of morbidity and mortality than the indication for transfusion. This shows again that randomised clinical trials are needed to find the optimal RBCT strategy during the perioperative care of paediatric cardiac surgery.

Jacques Lacroix