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Savorgnan F, Bhat PN, Checchia PA, et al. RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure. Crit Care Explor. 2021;3(5):e0417doi: 10.1097/CCE.0000000000000417.
Savorgnan, F., Bhat, P. N., Checchia, P. A., Acosta, S., Tume, S. C., Lasa, J. J., Asadourian, V., Achuff, B. J., Flores, S., Ahmed, M., Crouthamel, D. I., Loomba, R. S., & Bronicki, R. A. (2021). RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure. Critical care explorations, 3(5), e0417. https://doi.org/10.1097/CCE.0000000000000417
Savorgnan, Fabio, et al. "RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure." Critical care explorations vol. 3,5 (2021): e0417. doi: https://doi.org/10.1097/CCE.0000000000000417
Savorgnan F, Bhat PN, Checchia PA, Acosta S, Tume SC, Lasa JJ, Asadourian V, Achuff BJ, Flores S, Ahmed M, Crouthamel DI, Loomba RS, Bronicki RA. RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure. Crit Care Explor. 2021 May 20;3(5):e0417. doi: 10.1097/CCE.0000000000000417. eCollection 2021 May. PMID: 34036271; PMCID: PMC8140762.
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Crit Care Explor. 2021 May 20;3(5):e0417. doi: 10.1097/CCE.0000000000000417. eCollection 2021 May.

RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure.

Critical care explorations

Fabio Savorgnan, Priya N Bhat, Paul A Checchia, Sebastian Acosta, Sebastian C Tume, Javier J Lasa, Vicken Asadourian, Barbara-Jo Achuff, Saul Flores, Mubasheer Ahmed, Daniel I Crouthamel, Rohit S Loomba, Ronald A Bronicki

Affiliations

  1. Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
  2. Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
  3. Medical Informatics Corp, Houston, TX.
  4. Department of Data Science, Southern Methodist University, Dallas, TX.
  5. Department of Pediatrics, The Heart Institute, Advocate Children's Hospital, Chicago Medical School and Rosalind Franklin University of Medicine and Science, Oak Lawn, IL.

PMID: 34036271 PMCID: PMC8140762 DOI: 10.1097/CCE.0000000000000417

Abstract

The transfusion of stored RBCs decreases nitric oxide bioavailability, which may have an adverse effect on vascular function. We assessed the effects of RBC transfusion on coronary vascular function by evaluating the relationship between myocardial oxygen delivery and demand as evidenced by ST segment variability.

DESIGN: Retrospective case-control study.

SETTING: Nine-hundred seventy-three-bed pediatric hospital with a 54-bed cardiovascular ICU.

PATIENTS: Seventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt.

INTERVENTIONS: RBC transfusion.

MATERIALS AND MAIN RESULTS: High-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group.

CONCLUSIONS: We found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Keywords: Norwood procedure; electrocardiogram; hypoplastic left heart syndrome; neonate; nitric oxide; red blood cell transfusion

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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