Terumo Cardiovascular Group

Pediatric Blood Management Program Optimal With 3-Year-Olds

When the Medical College of Georgia Health Children's Medical Center decided to formally create a blood management program, the clinicians created a team — including surgeons and anesthesiologists — to determine their blood conservation equipment wish list. It included:

  • Low prime oxygenator
  • Cell saver
  • Cerebral monitor
  • Data management system

Although the Augusta, Georgia hospital has been performing open-heart surgery for 35 years, its pediatric blood management program is just one year old. With a new surgeon on board last year, the team examined how the practice could improve its blood conservation practices.

"We decided to start a program to better serve our patients," says Carol Ann Rosenberg, CCP, Chief Pediatric Perfusionist, MCGHealth Children's Medical Center.

Mrs. Rosenberg and her team knew that collaboration was essential. "We went to Administration and said we need to purchase other devices to implement a successful blood management strategy," says Mrs. Rosenberg. "It was a collaborative team effort. We were relentless and determined."

Case Study

The MCGHealth Children's Medical Center team determined that 3-year-old patients have the greatest benefit in their blood utilization program. Patients weighing up to 14 kg are still able to use the smallest oxygenator and smaller tubing — both factors in her estimated 200 ml of prime savings.

The MCGHealth blood management team also:

  • Reduced tubing to the oxygenators using the smaller 3/16 to ¼ tubing
  • Reduced circuit length and prime volume by using the smallest oxygenator with an integrated arterial line filter
  • Reduced circuit size by pole-mounting roller head pumps on its heart-lung machine.
  • Switched to a 1:4 cardioplegia ratio
  • Retrieves blood from the circuit and salvages it for retransfusion with an autotransfusion system.
  • Uses continuous monitoring to determine if the patient is hemodynamically stable.
  • Uses electronic charting — specifically the query feature — with a data management system. The team personalized their pediatric case template by patient weight, circuit size and oxygenator choice. "With the new government mandate on electronic charting, it made sense to use data management," says Mrs. Rosenberg. "It's a tool to help the blood conservation program because we can query cases by those who have received blood and those who haven't."

"It's been a nine-month process and we've seen a reduction in blood consumption and a reduction in hospital length of stay," says Mrs. Rosenberg. "The hospital administration is impressed with what we've done with the open heart program."