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Post-operative blood loss following cardio-pulmonary bypass in children
D A Evans1, R L Holder, W J Brawn
1Department of Cardiac Surgery, Children's Hospital, Ladywood Middleway, Birmingham, UK.
Insights
Predicting post-operative bleeding after cardio-pulmonary bypass in children is crucial. Lower esophageal temperature predicts blood loss, while longer bypass times and abnormal coagulation predict re-exploration needs.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Cardiology
- Anesthesiology
Background:
- Post-operative bleeding after cardio-pulmonary bypass is a significant concern in pediatric cardiac surgery.
- Early re-exploration due to excessive bleeding can lead to increased morbidity and mortality in children.
Purpose of the Study:
- To identify pre-operative, operative, and post-operative variables that predict post-operative blood loss in children undergoing cardio-pulmonary bypass.
- To determine if these variables can predict the need for early re-exploration for bleeding within 12 hours of surgery.
Main Methods:
- Prospective study of 206 pediatric patients undergoing cardio-pulmonary bypass over a 9-month period.
- Analysis of pre-operative, operative, and immediate post-operative variables to predict blood loss and re-exploration.
- Development of a nomogram to correlate re-exploration with hourly post-operative blood loss.
Main Results:
- Minimum esophageal temperature was the only significant predictor of post-operative blood loss (r = -0.19, P < 0.05), with lower temperatures associated with greater bleeding.
- Longer cardio-pulmonary bypass times (P < 0.05) and abnormal pre-operative coagulation indices (P < 0.01) were significant independent predictors of re-exploration for bleeding.
- Early re-exploration was necessary in 8 out of 206 patients.
Conclusions:
- Esophageal temperature is a key intra-operative factor influencing post-operative blood loss in pediatric cardiac surgery.
- Pre-operative coagulation status and bypass duration are critical for predicting the need for re-exploration due to bleeding.
- A practical nomogram can aid in assessing the risk of re-exploration based on hourly blood loss.
Abstract:
Significant post-operative bleeding may occur following cardio-pulmonary bypass, sometimes necessitating early re-exploration. Two questions were asked by this study. Firstly, in children undergoing cardio-pulmonary bypass, can pre-operative, operative and immediately post-operative variables be used to predict post-operative blood loss? Secondly, in the same patient group, can the same variables be used to predict the surgical intervention of re-exploration for excessive bleeding within 12 h of surgery? In a prospective study of patients operated on in a 9-month period, bleeding fell rapidly in the first 3 h after surgery and early re-exploration for bleeding was necessary in 8 of the 206 patients. The only significant predictor of post-operative blood loss was minimum oesophageal temperature, low values being associated with greater blood loss (correlation r = -0.19 (P < 0.05)). With regard to re-exploration for bleeding, a long bypass time (P < 0.05) and abnormal pre-operative coagulation indices (P < 0.01) were significant and independent predictors. The data were also used to create a practical nomogram relating re-exploration for bleeding to hourly post-operative blood loss.