Introduction of modified blood priming technique in the neonatal and infant populations undergoing congenital heart surgery

Background

Allogenic blood product transfusion has well-documented risks and adverse outcomes. To limit perioperative transfusions for neonates and infants undergoing cardiac surgery, our institution launched a blood conservation program in May, 2021. Over the past several years, our standard has changed from blood priming the cardiopulmonary bypass (CPB) circuit for most patients ≤12 kilograms (kg) to administering an asanguinous prime to all patients with an adequate baseline hematocrit (HCT), regardless of weight. For those requiring transfusion, the technique of modified blood priming (MBP), introduced herein, presents an intermediate solution between a clear and standard blood prime, with the goal of administering the minimum amount of packed red blood cells (PRBC) to maintain safe oxygen-carrying capacity while on CPB.