Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture

Matthew F Mikulski; Antonio Linero; Daniel Stromberg; Jeremy T Affolter; Charles D Fraser; Carlos M Mery; Richard P Lion

doi:10.1017/S104795112400009X

Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture

Cardiol Young. 2024 Mar 7:1-8. doi: 10.1017/S104795112400009X. Online ahead of print.

Authors

Matthew F Mikulski^{1

2}, Antonio Linero³, Daniel Stromberg^{1

4}, Jeremy T Affolter^{1

4}, Charles D Fraser^{1

2}, Carlos M Mery^{1

2}, Richard P Lion^{1

4}

Affiliations

¹ Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.
² Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
³ Department of Statistics and Data Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA.
⁴ Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.

PMID: 38450505
DOI: 10.1017/S104795112400009X

Abstract

Background: 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.

Methods: 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 (Sickbay^TM) 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.

Results: 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.

Conclusions: 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.

Keywords: High-fidelity telemetry; Oxygen delivery; Red blood cell transfusion.