Related Experiment Video
Updated: Oct 7, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Evaluating the Impact of Cardiopulmonary Bypass Priming Fluids on Bleeding After Pediatric Cardiac Surgery: A
K Siemens1, P Donnelly1, B J Hunt2
1PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom.
Insights
Cardiopulmonary bypass (CPB) priming fluids did not significantly affect pediatric perioperative bleeding. This systematic review found no evidence that different solutions impact blood loss in children undergoing cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Coagulopathy Research
- Cardiovascular Anesthesia
Background:
- Cardiopulmonary bypass (CPB) is associated with coagulopathy in pediatric patients.
- Understanding the impact of CPB priming fluids on bleeding is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effect of different cardiopulmonary bypass priming fluids on perioperative bleeding in pediatric cardiac surgery.
- To systematically review randomized controlled trials (RCTs) investigating CPB priming solutions.
Main Methods:
- Systematic review and meta-analysis of 20 RCTs published between 1980 and 2020.
- Included patients under 18 years without hematologic disorders.
- Primary outcome: postoperative bleeding; secondary outcomes: transfusion, mortality, safety.
Main Results:
- No significant difference in 24-hour blood loss was found between different CPB priming solutions (mean difference -0.13; p=0.92).
- Fresh frozen plasma (FFP), albumin, and artificial colloids were frequently assessed interventions.
- Heterogeneity in study design, population, and interventions limited definitive conclusions.
Conclusions:
- Current evidence does not support a significant effect of various CPB priming solutions on 24-hour blood loss in pediatric cardiac surgery.
- Limitations include heterogeneity across studies, impacting the strength of conclusions.
- Further research with standardized methodologies is warranted.
Objectives:
Cardiopulmonary bypass (CPB) predisposes young children to coagulopathy. The authors evaluated possible effects of CPB priming fluids on perioperative bleeding in pediatric cardiac surgery.
Design:
Meta-analysis and systematic review of previously published studies.
Setting:
Each study was conducted in a surgical center or intensive care unit.
Participants:
Studies investigating patients <18 years without underlying hematologic disorders were included.
Interventions:
The authors evaluated randomized controlled trials (RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and CENTRAL databases. The primary outcome was postoperative bleeding; secondary endpoints included blood product transfusion, mortality, and safety.
Measurements And Main Results:
Twenty eligible RCTs were analyzed, with a total of 1,550 patients and a median of 66 patients per study (range 20-200). The most frequently assessed intervention was adding fresh frozen plasma (FFP) to the prime (8/20), followed by albumin (5/20), artificial colloids (5/20), and blood-based priming solutions (3/20). Ten studies with 771 patients evaluated blood loss at 24 hours in mL/kg and were included in a meta-analysis. Most of them investigated the addition of FFP to the priming fluid (7/10). No significant difference was found between intervention and control groups, with a mean difference of -0.13 (-2.61 to 2.34), p = 0.92, I2 = 69%. Further study endpoints were described but their reporting was too heterogeneous to be quantitatively analyzed.
Conclusions:
This systematic review of current evidence did not show an effect of different CPB priming solutions on 24-hour blood loss. The analysis was limited by heterogeneity within the dataset regarding population, type of intervention, dosing, and the chosen comparator, compromising any conclusions.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management