Packed red blood cell transfusions occur frequently after congenital heart surgery to augment haemodynamics, with limited understanding of efficacy. The goal of this study was to analyse the hemodynamic response to packed red blood cell transfusions in a single cohort, as “proof-of-concept” utilising high-frequency data capture of real-time telemetry monitoring.

Retrospective review of patients after the arterial switch operation receiving packed red blood cell transfusions from 15 July 2020 to 15 July 2021. Hemodynamic parameters were collected from a high-frequency data capture system (SickbayTM) continuously recording vital signs from bedside monitors and analysed in 5-minute intervals up to 6 hours before, 4 hours during, and 6 hours after packed red blood cell transfusions—up to 57,600 vital signs per packed red blood cell transfusions. Variables related to oxygen balance included blood gas co-oximetry, lactate levels, near-infrared spectroscopy, and ventilator settings. Analgesic, sedative, and vasoactive infusions were also collected.

Six patients, at 8.5[IQR:5-22] days old and weighing 3.1[IQR:2.8-3.2]kg, received transfusions following the arterial switch operation. There were 10 packed red blood cell transfusions administered with a median dose of 10[IQR:10-15]mL/kg over 169[IQR:110-190]min; at median post-operative hour 36[IQR:10-40]. Significant increases in systolic and mean arterial blood pressures by 5-12.5% at 3 hours after packed red blood cell transfusions were observed, while renal near-infrared spectroscopy increased by 6.2% post-transfusion. No significant changes in ventilation, vasoactive support, or laboratory values related to oxygen balance were observed.

Packed red blood cell transfusions given after the arterial switch operation increased arterial blood pressure by 5-12.5% for 3 hours and renal near-infrared spectroscopy by 6.2%. High-frequency data capture systems can be leveraged to provide novel insights into the hemodynamic response to commonly used therapies such as packed red blood cell transfusions after paediatric cardiac surgery.

Hyperglycaemia has been identified as a risk factor for adverse outcomes in critically ill patients, including those who have undergone cardiopulmonary bypass. Tight glucose control with insulin therapy has been shown to improve outcomes, but is not common practice for children following cardiopulmonary bypass. We examined the relationship between blood glucose level and systemic and cerebral oxygen transport in a uniform group of neonates after the Norwood procedure.

Systemic oxygen consumption was measured using respiratory mass spectrometry in 17 neonates for 72 hours postoperatively. Cardiac output, systemic and total pulmonary vascular resistances – including the Blalock–Taussig shunt, systemic oxygen delivery and oxygen extraction ratio, as well as arterial lactate and glucose, were measured at 2- to 4-hour intervals. Cerebral oxygen saturation was measured by near-infrared spectroscopy.

Blood glucose levels ranged from 2.8 to 24.6 millimoles per litre. Elevated glucose level showed a significant negative correlation with cardiac output (p = 0.02) and cerebral oxygen saturation (p = 0.03), and a positive correlation with oxygen extraction ratio (p = 0.03). It tended to correlate positively with systemic vascular resistance (p = 0.09) and negatively with oxygen delivery (p = 0.09), but did not correlate with oxygen consumption (p = 0.13).

Hyperglycaemia is negatively associated with systemic haemodynamics, oxygen transport, and cerebral oxygenation status in neonates after the Norwood procedure. Further study is warranted to examine tight glucose control with insulin therapy on postoperative systemic and cerebral oxygen transport and functional outcomes in neonates after cardiopulmonary bypass.

To determine the safety and possible efficacy of diaspirin cross-linked hemoglobin (DCLHb) in the treatment of patients in Class II–IV hemorrhagic, hypovolemic shock.

Multicenter, randomized, normal saline-controlled, dose-escalation study.

Eleven hospitals in the U.S. and Belgium.

One hundred and thirty-nine (139) hospitalized patients with Class II–IV hemorrhagic, hypovolemic shock within the previous 4 hours who still were requiring therapy for shock.

Beginning with the lowest dose, patients were randomized to receive 50,100, or 200 mL of either 10% DCLHb or normal saline infused intravenously over 15 minutes. Following infusion of either treatment, further fluid resuscitation could be given, as necessary, to maintain perfusion. Vital signs, laboratory assessments, blood and fluid administration, complications, and adverse events were recorded at various times from the end of infusion through 72 hours after infusion.

A total of 29 (13 DCLHb- and 16 saline-treated) patients died during the study period. Adverse events were experienced by 61% of patients in the DCLHb group and 53% of patients in the saline group; serious adverse events occurred in 28% of DCLHb-treated patients and 30% of saline-treated patients. The incidence of prospectively defined, clinical complications, including renal insufficiency and renal failure, was similar between the treatment groups except for the occurrence of dysrhythmias/conduction disorders, which occurred significantly more frequently in the saline-treated patients than the DCLHb-treated patients (p = 0.041). At the highest dose level (200 mL), statistically significant between-group differences were observed with greater increases in serum amylase, LDH, the isoenzymes LD1,2,4 and 5, and CK-MB in the DCLHb group compared to the control group; none were of clinical significance. The volume of blood administered did not differ between the groups. Overall 24- and 72-hour survival rates were similar between treatment groups, although the hospital discharge rate was slightly higher in the DCLHb-treated patients (80%) compared with the saline-treated patients (74%).

Administration of 50 to 200 mL of DCLHb to patients in hemorrhagic, hypovolemic shock was not associated with evidence of end organ toxuity or significant adverse events. Further studies involving larger doses and, perhaps, earlier administration of DCLHb are warranted.