A0021 To Study the Outcome of Massive Transfusion in Pediatric Patients Undergoing Elective Craniotomy: A Retrospective Descriptive Study

Background: Children undergoing surgical resection of vascular tumor and malformations are at a great risk of rapid, massive blood loss. The primary goals while managing these children who need massive transfusion are avoiding hypotension, maintaining adequate CPP and oxygenation. Goals are achieved by transfusing appropriate volume of blood and blood products at an appropriate time to facilitate faster recovery with minimal complications.

Materials and Methods: Children who received blood transfusion during the elective craniotomy over a period of 5 years were taken from the computerized hospital in-patient data source (CHIPS), of whom, those who had > 50% volume loss in 3 hours were analyzed. Out of 140 children who received transfusion during elective craniotomy, a total of 26 children received massive transfusion. All charts were analyzed in detail. Patient demographics, preoperative, intraoperative factors were correlated with postoperative factors to predict the morbidity and mortality.

Results: Demographics (median and interquartile range [IQR]): Age 4 (2–12) years; weight 14 (11–30) kg; height 91 (46–136) cm; BMI 13 (9–17) kg/m², male-to-female ratio 16:10. Four out of 26 children had congenital anomalies. Intraoperative parameters: Average preoperative Hb was (median IOR) 10 (8–12) g/dL. 16/26 (61%) received inhalational anesthetic and 10/26 (39%) received both inhalational and TIVA for maintenance. Regarding the IV access, 25/26 (96%) of children had two peripheral lines along with one central line. 12/26 (46%) children received tranexamic acid. Average blood loss was 52.5 ± 34.5 mL/kg. 14/26 (53%) children had intraoperative hemodynamic instability who needed noradrenaline, 9 had no hemodynamic instability, and 1 had severe instability and needed both adrenaline and noradrenaline. Fourteen (54%) of 26 children had metabolic acidosis, and more than 30% patients had electrolyte abnormality of which hypocalcemia was the commonest followed by hypokalemia. Average amount of PRBC transfusion was 40.7 ± 26.5 mL/kg; WBC 25.7 ± 12.7 mL/kg; FFP 20.5 ± 12.8 mL/kg; platelets 7.7 ± 4.05 mL/kg; and cryo 4.77 ± 2.32 mL/kg. 3 patients (22.5%) had mild transfusion reaction and needed antihistamine and steroids. Postoperative parameters: Out of 26 patients, 11 (42.3%) were electively ventilated for average of 23 hours. 6/26 patients (23.1%) were on inotropic support for 10 to 21 hours. Average days of ICU and hospital stay were 1.5 and 10 days, respectively. 11/26 had postoperative complication. There was no death reported in this series.

Conclusions: Anticipation, preparation, and aggressive intraoperative resuscitation with blood and blood products during massive blood loss reduce the postoperative morbidity and mortality.