Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS

Area of Science:

• Pediatric Cardiac Surgery
• Extracorporeal Life Support
• Hemostasis and Thrombosis

Background:

• Limited literature exists on bleeding patterns in pediatric post-cardiotomy patients requiring extracorporeal life support (ECLS).
• Understanding bleeding complications is crucial for managing these high-risk patients.

Purpose of the Study:

• To retrospectively review bleeding complications in pediatric post-cardiotomy patients on ECLS.
• To identify risk factors associated with excessive bleeding in this population.

Main Methods:

• Retrospective review of 145 pediatric patient records.
• Classification of patients into excessive (E) and non-excessive (NE) bleeding groups based on blood loss.
• Analysis of bleeding patterns and associated clinical factors.

Main Results:

• Excessive bleeding predominantly occurred within the first 0-6 hours post-ECLS.
• Longer cardiopulmonary bypass (CPB) duration and lower platelet counts were significantly associated with increased bleeding in the first 6 hours (p=0.005).
• Intraoperative protamine use with normal platelets correlated with reduced bleeding between 7-12 hours post-ECLS (p=0.002).

Conclusions:

• The majority of bleeding in pediatric post-cardiotomy patients on ECLS happens early after support initiation.
• Longer CPB time and thrombocytopenia are key risk factors for early post-ECLS bleeding.
• Strategies to minimize bleeding include protamine administration, aggressive blood product replacement targeting 100-120K platelets, and timely surgical exploration if needed.