A new approach to massive blood transfusion during pediatric liver resection

Morbidity and death during liver resection in children are due to hemorrhage and the consequences of massive transfusion. To overcome these problems, a new rapid method of blood transfusion was used in four children (8 to 35 months, 8.6 to 13 kg) undergoing extensive hepatic resection for tumor (tumor weight, 440 to 1625 gm). The rapid infusion device consisted of a roller pump and a bubble oxygenator-warmer circuit primed with washed packed red cells resuspended in fresh-frozen plasma and calcium-free balanced salt solution (Plasmalyte). The infusate was warmed, oxygenated, and buffered before it was administered. An average of 5130 ml per patient of this reconstituted blood was infused at an average rate of 122 ± 45 ml/min, with peak infusion rates sometimes as great as 1 L/min. Cardiac output, pulmonary artery wedge pressure, body temperature, urine output, blood gases, blood chemistries, and coagulation factors remained unchanged during and after these massive transfusions. Blood transfusion at rapid rates required during pediatric liver resection can be accomplished safely if the storage lesion of the bank blood is previously corrected.