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Effects of Modified Ultrafiltration on Thromboelastographic Profile after Pediatric Cardiac Surgery
Umair Abbas1, Rohit S Loomba1, Cynthia Urbas1
1Advocate Children's Hospital, Oak Lawn, Illinois.
Abstract:
Modified ultrafiltration (MUF) is still used after pediatric cardiopulmonary bypass (CPB) in some pediatric cardiac surgery centers to decrease transfusion requirements. Other potential benefits of MUF include clearance of inflammatory markers and improvement in myocardial function. Our hypothesis is that MUF will hemoconcentrate coagulation factors and improve thromboelastography (TEG) parameters after pediatric CPB. Patients younger than 6 months were prospectively enrolled over a year. TEG was carried out before MUF, after MUF, and after protamine administration. Paired t tests were conducted to compare values pre-MUF and post-MUF as well as post-MUF and post-protamine administration. Thirty patients were enrolled in the study, with 20 (67%) neonates in the cohort. Seven arterial switch operations and nine Norwood procedures were found to be performed among the cohort. Reaction time (R), angle (α), and maximum amplitude (MA) were significantly worse post-MUF compared with pre-MUF (p < .001). They improved significantly after protamine administration compared with post-MUF (p < .001). The amount of fluid removal was significantly associated with a worse post-MUF R, angle, and MA and worse post-protamine administration, angle, and MA but with no effect on post-protamine R. MUF caused worsening of TEG parameters that is reversed by protamine administration.
Insights
Modified ultrafiltration (MUF) after pediatric cardiopulmonary bypass (CPB) worsens coagulation. Protamine administration reversed these negative effects, suggesting MUF may not benefit coagulation in neonates undergoing cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hematology
Background:
- Modified ultrafiltration (MUF) is employed post-pediatric cardiopulmonary bypass (CPB) to reduce transfusions and potentially improve outcomes.
- Its effects on coagulation status and thromboelastography (TEG) parameters in neonates remain incompletely understood.
Purpose of the Study:
- To investigate the impact of MUF on coagulation factors and TEG parameters in infants undergoing cardiac surgery.
- To determine if MUF influences thromboelastography (TEG) measurements in neonates post-pediatric cardiopulmonary bypass (CPB).
Main Methods:
- Prospective enrollment of pediatric patients (<6 months) undergoing cardiac surgery.
- Thromboelastography (TEG) analysis performed before MUF, after MUF, and after protamine administration.
- Paired t tests used to compare TEG parameters at different time points.
Main Results:
- MUF significantly worsened TEG parameters (R, α, MA) compared to pre-MUF values.
- Coagulation parameters significantly improved after protamine administration compared to post-MUF.
- Greater fluid removal during MUF correlated with worse post-MUF and post-protamine TEG values.
Conclusions:
- Modified ultrafiltration (MUF) negatively impacts coagulation parameters in neonates after pediatric cardiopulmonary bypass (CPB).
- The adverse effects of MUF on coagulation are reversible with protamine administration.
- These findings question the routine use of MUF for improving coagulation in this patient population.
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