Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation Jill M. Cholette, MD, Michael.

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Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation Jill M. Cholette, MD, Michael F. Swartz, PhD, Jeffrey Rubenstein, MD, Kelly F. Henrichs, MT(ASCP), Hongyue Wang, PhD, Karen S. Powers, MD, L. Eugene Daugherty, MD, George M. Alfieris, MD, Francisco Gensini, MD, Neil Blumberg, MD The Annals of Thoracic Surgery Volume 103, Issue 1, Pages 206-214 (January 2017) DOI: 10.1016/j.athoracsur.2016.05.049 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 CONSORT diagram of infants randomly assigned to a conservative or liberal transfusion protocol. (BiV = biventricular; CPB = cardiopulmonary bypass; ECMO = extracorporeal membrane oxygenation; FU = follow-up; Pa = palliative; RBC = red blood cell.) The Annals of Thoracic Surgery 2017 103, 206-214DOI: (10.1016/j.athoracsur.2016.05.049) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Hemoglobin (Hb) concentrations for infants randomly assigned to a conservative (Cons) or liberal (Lib) transfusion protocol. (A) Admission and discharge Hb concentrations between the groups. (B) Admission and discharge Hb concentrations between infants with palliation (Pa) and biventricular (BiV) repairs. (C) Lowest Hb concentrations between the groups. (D) Comparison of mean daily Hb concentrations for all patients. *Statistically significant between transfusion groups; #statistically significant for a lower discharge than admission Hb concentrations; †statistically significant for a greater discharge than admission Hb concentration. The Annals of Thoracic Surgery 2017 103, 206-214DOI: (10.1016/j.athoracsur.2016.05.049) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Comparison of the number of red cell transfusions for (A) all patients, (B) biventricular (BiV) patients, and (C) palliated (Pa) patients and (D) volume of red blood cells (RBC) transfused. The Annals of Thoracic Surgery 2017 103, 206-214DOI: (10.1016/j.athoracsur.2016.05.049) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Comparison of peak daily arterial lactate concentrations for (A) all patients, (B) biventricular (BiV) patients, and (C) palliated (Pa) patients and (D) percentage of lactate time greater than 2.0. The Annals of Thoracic Surgery 2017 103, 206-214DOI: (10.1016/j.athoracsur.2016.05.049) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Comparison of the (A) overall estimated arteriovenous difference (est AV diff), (B) daily average est AV diff for all patients, and (C, D) before-and-after red cell transfusions for all patients. An arteriovenous oxygen difference (avO2diff) of 3.5 to 5.0 mL O2/100 mL was considered normal and is demarcated. *Statistically significant between conservative and liberal patients. (BiV = biventricular; Hb = hemoglobin; Pa = palliative; Trans = transfusion.) The Annals of Thoracic Surgery 2017 103, 206-214DOI: (10.1016/j.athoracsur.2016.05.049) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions