Le Bonheur Children's takes aggressive steps to minimize blood loss during heart surgery

More than 20 percent of Le Bonheur Children's Hospital's open heart surgeries are now bloodless, meaning no blood or blood products given during surgery. The Memphis, Tenn., hospital's Heart Institute has been taking aggressive steps to minimize blood loss during surgery and reduce perioperative blood transfusions over the last 18 months.

"Blood transfusions increase a patient's risk of developing complications; it's like getting a mini transplant," said Chief Perfusionst Jerry Allen, CCP. "Blood transfusions are a known cause of whole body inflammation and have been linked to increased morbidity and mortality after cardiac surgery."

For children weighing more than 34 pounds, more than 60 percent will have bloodless surgery, even if they are undergoing multiple reoperations, says Allen. 

Allen's team has focused on decreasing the cardiopulmonary bypass (CPB) circuit surface area, using shorter tube lengths and decreasing tubing diameters. This allows for less contact between the patient's blood and tubing, thus reducing the risk of inflammation and other complications.

In a retrospective study presented at Le Bonheur in August, perfusionists reported that before August 2012, 50 percent of patients received two or more units of packed red blood cells during or after open heart surgery. Subsequently, using the newer, more efficient circuits only 11 percent of patients required two or more units of blood, and in 20 percent of cases, no blood was used at all.

"Our goal here at Le Bonheur is to achieve a 90 percent bloodless surgery for patients that weigh more than 34 pounds," said Allen. "We will continue to find ways to reduce our circuit volume by embracing new technologies and adopting new techniques in our practice."