Hemostatic derangements associated with cardiopulmonary bypass predict outcomes in pediatric patients undergoing corrective heart surgery
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Published on: May 26, 2023
Kevin Todd1, Spencer J Hogue2, James S Tweddell2
1Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Insights
Pediatric cardiopulmonary bypass (CPB) alters hemostatic factors. Low platelets and Factor VIII levels post-CPB correlate with increased bleeding and longer hospital stays, suggesting potential targets for improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Hematology
Background:
- Limited understanding exists regarding hemostatic and complement system alterations during pediatric cardiopulmonary bypass (CPB).
- The impact of these CPB-associated changes on patient outcomes remains largely uncharacterized.
Purpose of the Study:
- To prospectively investigate hemostatic and complement alterations in pediatric patients undergoing CPB.
- To determine the association between these biomarker changes and postoperative clinical outcomes.
Main Methods:
- Prospective enrollment of pediatric patients (<21 years, >3 kg, >36 weeks gestational age) undergoing CPB.
- Analysis of hemostatic and complement biomarkers pre-, intra-, and 24 hours post-CPB.
- Correlation of biomarker levels with clinical outcomes, including chest tube output (CTO).
Main Results:
- CPB induced significant alterations in hemostatic and complement components.
- Lower postoperative platelet counts and Factor VIII (FVIII) levels were associated with increased CTO.
- Lower FVIII levels also correlated with longer hospital stays; single ventricle reconstruction patients showed higher CTO.
Conclusions:
- Intraoperative hemostatic system changes during pediatric CPB may predict postoperative outcomes.
- Further research is warranted to explore interventions targeting platelets or FVIII to improve pediatric CPB outcomes.
Background:
Understanding of the hemostatic and complement alterations associated with cardiopulmonary bypass (CPB) in pediatric patients and the impact of these alterations on outcome is limited.
Objectives:
The present study prospectively characterized these alterations and their association with postoperative outcomes in pediatric CPB.
Methods:
All patients aged <21 years undergoing CPB at the authors' institution between 2020 and 2021 who weighed >3 kg, were >36 weeks gestational age, and had no known prothrombotic or hemorrhagic disorders were eligible. Blood samples were analyzed for multiple hemostatic and complement biomarkers pre-, intra-, and 24 hours post-CPB. Biomarker levels were compared to clinical outcomes, including chest tube output (CTO).
Results:
Fifty consecutive patients were enrolled. CPB resulted in multiple significant alterations in hemostatic and complement components. Lower platelet counts (<80 × 109 platelets/L) at CPB termination were associated with increased postoperative CTO (P = .003). Lower factor (F)VIII levels (<60 IU/dL) at the end of CPB were associated with a longer hospital stay (P < .001) and increased postoperative CTO (P < .001). Patients undergoing staged single ventricle reconstruction were more likely to have lower platelet counts at CPB termination (P = .009) and higher CTO postoperatively (P = .001) than patients undergoing other types of surgical repair. These differences were not due to different preoperative platelet counts, increased incidences of circulatory arrest, or longer CPB times.
Conclusion:
These data suggest that intraoperative alterations in hemostatic system components may predict postoperative outcomes in pediatric CPB. Further study is needed to determine if interventions targeting platelets or FVIII could improve outcomes in pediatric CPB.
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