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Transfusing Platelets During Bypass Rewarming in Neonates Improves Postoperative Outcomes: A Randomized Controlled
Nischal K Gautam1, James Pierre1, Kayla Edmonds1
1Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA.
World Journal for Pediatric & Congenital Heart Surgery
|December 15, 2019
Summary
Administering platelets during rewarming in neonatal cardiac surgery significantly reduced blood product transfusions and improved patient outcomes. This strategy enhances hemostasis compared to post-bypass transfusion.
Area of Science:
- Cardiovascular Surgery
- Neonatal Medicine
- Hematology
Background:
- Current practice transfuses platelets after cardiopulmonary bypass (CPB) in neonates.
- This study investigates an alternative timing for platelet administration during CPB.
Purpose of the Study:
- To evaluate the efficacy of administering platelets during the rewarming phase of CPB.
- To determine if this strategy reduces coagulopathy and improves outcomes in neonatal cardiac surgery.
Main Methods:
- A prospective, randomized trial involving 46 neonates undergoing cardiac surgery.
- The treatment group received platelets during rewarming; the control group received them post-bypass.
- Post-protamine management and transfusion protocols were standardized.
Main Results:
- The rewarming group required 40% fewer post-bypass blood products (P=.04).
- Faster case completion (P=.016), fewer mediastinal explorations (P=.045), and lower fluid balance (P=.04) were observed.
- Shorter mechanical ventilation (P=.016) and ICU stays (P=.033) were noted.
Conclusions:
- Platelet transfusion during the rewarming phase improves outcomes in neonatal cardiac surgery.
- This timing is associated with reduced bleeding and enhanced postoperative recovery compared to post-bypass transfusion.
