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Sonoclot® predicts operation time and blood loss after cardiopulmonary bypass in children
Hidehisa Saito1,2, Shin Kawana3, Kazutomo Saito1
1Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Insights
In pediatric cardiac surgery, Sonoclot® monitoring revealed that prolonged cardiopulmonary bypass (CPB) time impairs platelet function, increasing blood loss. Early transfusion of fresh frozen plasma (FFP) or platelet concentrate (PC) may reduce post-operative bleeding.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis and Thrombosis
- Point-of-Care Testing
Background:
- Pediatric patients have limited blood volume, making bleeding management challenging, especially during cardiac surgery.
- Cardiopulmonary bypass (CPB) in pediatric cardiac surgery can lead to significant loss of clotting factors, exacerbating bleeding and prolonging operations.
- Understanding the relationship between clotting factors and blood loss is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To evaluate the utility of Sonoclot® viscoelastic point-of-care testing for assessing coagulation function in pediatric patients undergoing cardiac surgery.
- To investigate the correlation between coagulation parameters, CPB duration, and post-operative blood loss.
- To assess the impact of fresh frozen plasma (FFP) and platelet concentrate (PC) administration on coagulation and bleeding.
Main Methods:
- A retrospective analysis of 55 pediatric patients undergoing cardiac surgery with CPB.
- Sonoclot® analysis was performed pre- and post-CPB to assess coagulation function, including activated coagulation time (ACT_SC) and clot rate (CR_SC).
- Multiple regression analysis was used to compare post-CPB Sonoclot® data with operation time and blood loss, examining the effects of FFP and PC transfusions.
Main Results:
- Prolonged CPB time significantly worsened post-platelet function (PF_SC) and correlated with increased post-CPB bleeding and operation time.
- Higher transfusion volumes of PC were associated with lower PF_SC, and both FFP and PC volumes correlated with bleeding and operation duration.
- While FFP administration did not significantly alter CR_SC, it led to a decline in PF_SC, particularly with extended CPB duration.
Conclusions:
- Sonoclot® is a valuable tool for monitoring coagulation status in pediatric cardiac surgery patients on CPB.
- Proactive administration of FFP and PC during CPB may effectively mitigate post-operative bleeding.
- Optimizing coagulation management through point-of-care testing can improve surgical outcomes in this vulnerable population.
Background:
As the circulating blood volume is relatively small in pediatric patients, blood components are quickly lost when bleeding, which make it more difficult to stop the bleeding. Particularly in pediatric cardiac surgery, loss of clotting factors associated with cardiopulmonary bypass (CPB) would likely to be prominent. As a result, bleeding is further promoted and the operation time is extended. In order to search for the relation between clotting factors and the amount of bleeding, we used a viscoelastic point of care test.
Objectives:
We used Sonoclot® as viscoelastic point of care test to evaluate coagulation function before CPB and before weaning from CPB in pediatric cardiac surgery.
Design:
Retrospective.
Setting:
Single-institutional.
Participants:
We included 55 pediatric patients (median age 13 months [IQR 5-32]) who underwent cardiac surgery under CPB from December 2015 to November 2016.
Interventions:
None.
Measurements And Main Results:
Sonoclot® analysis was performed after induction of anesthesia (pre-data, or baseline data) and before any heparinized saline was given, and right after modified ultrafiltration after weaning from CPB (post-data). Post-data was compared with post-CPB operation time and post-CPB blood loss by multiple regression analysis. Furthermore, effects of fresh frozen plasma (FFP) added on CPB on coagulation function and post-platelet function (describe as PFSC) was assessed. Activated coagulation time (describe as ACTSC) and clot rate (describe as CRSC) showed no significant change between baseline data and post-data. Post-PFSC was worsened by prolonged CPB time (p < 0.05) and correlated to bleeding amount and operation time after CPB (p < 0.05). Total amount of platelet concentrate (PC) transfused was higher in patients with smaller PFSC (p < 0.05). Total amount of FFP and PC transfused correlated with bleeding amount and operation time after CPB (p < 0.05). In the subgroup analysis, PFSC declined in the FFP-included group, whereas there was no significant difference in coagulation function. Addition of FFP to CPB did not significantly affect CR, whereas PFSC deteriorated as CPB time was prolonged (CPB time = 1/(0.0021∗PFSC + 0.0055)).
Conclusion:
Sonoclot® is useful to evaluate coagulation function in pediatric patients who undergo CPB. Preventive administration of FFP or PC in CPB circuit could reduce bleeding after CPB.
