Point of care testing in children undergoing cardiopulmonary bypass

Area of Science:

• Pediatric cardiac surgery
• Hemostasis and thrombosis
• Point-of-care testing

Background:

• Excessive hemorrhage is a significant complication following cardiac surgery with cardiopulmonary bypass (CPB).
• Identifying reliable methods to predict bleeding risk in pediatric patients undergoing CPB is crucial.

Purpose of the Study:

• To evaluate the utility of cone and platelet analyzer (CPA) and rotating thromboelastogram (ROTEM) as point-of-care tests for predicting bleeding risk in pediatric patients undergoing CPB.
• To correlate CPA and ROTEM parameters with perioperative blood loss and transfusion requirements.

Main Methods:

• Prospective study of 15 pediatric patients (1 month to 10 years) undergoing CPB.
• Measurement of blood count, coagulation tests (PT, aPTT, fibrinogen, thrombin time), CPA, and ROTEM parameters pre- and post-CPB.
• Recording of demographic, surgical, and perioperative bleeding data.

Main Results:

• Low body weight, longer CPB duration, and lower core body temperature were associated with increased bleeding risk.
• ROTEM showed prolonged clotting time and decreased maximal clot firmness (MCF) postoperatively in patients with increased bleeding.
• Preoperative prolonged PT and low fibrinogen, along with postoperative low MCF, correlated with increased bleeding; CPA findings were not associated with bleeding.

Conclusions:

• CPA is not a reliable prognostic tool for predicting bleeding risk in pediatric patients undergoing CPB.
• ROTEM parameter changes post-CPB are associated with bleeding tendency and may predict impaired clot formation and stability.