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Mediastinal bleeding after cardiopulmonary bypass in pediatric patients
1Department of Anesthesia, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Insights
Fresh whole blood effectively reduces blood loss in young children undergoing complex heart surgeries. Further research is needed on other strategies for managing bleeding in pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis Management
- Transfusion Medicine
Background:
- Children undergoing cardiac operations often require allogeneic blood transfusions.
- Developing clinical recommendations can help reduce transfusion needs in this population.
Purpose of the Study:
- To create simple clinical guidelines for minimizing allogeneic blood transfusions in pediatric cardiac surgery.
- To evaluate strategies for hemostasis in children undergoing heart operations.
Main Methods:
- Literature review on hemostasis in pediatric cardiac surgery.
- Re-examination of strategies: on-site coagulation monitoring, fresh whole blood transfusion, desmopressin, epsilon-aminocaproic acid, and aprotinin.
Main Results:
- Infants (<6 months) experience factor dilution and decreased platelets during cardiopulmonary bypass.
- Fresh whole blood is effective in reducing blood loss in children under 2 years.
- Desmopressin showed no benefit; other agents require further pediatric cardiac surgery evaluation.
Conclusions:
- Recommend fresh whole blood for children under 2 undergoing complex heart operations to reduce blood loss.
- Post-cardiopulmonary bypass bleeding management should be tailored to patient age and coagulation status.
Background:
The purpose of our review was to develop simple clinical recommendations to reduce the need for allogeneic blood transfusions in children undergoing cardiac operations.
Methods:
The literature on hemostasis as it relates to children, cardiac disease in children, and pediatric heart surgery was reviewed. We also reexamined the efficacy of several strategies in this patient population: on-site monitoring of coagulation, transfusion of fresh whole blood, and administration of desmopressin, epsilon-aminocaproic acid, or aprotinin.
Results:
Children with heart disease may present with preoperative thrombocytopenia, reduced platelet aggregation, and a decreased level of von Willebrand factor. Infants less than 6 months of age show a significant dilution of coagulation factors and decreased platelet counts during cardiopulmonary bypass. Fresh whole blood reduces blood loss in children younger than 2 years undergoing complex operations. Desmopressin does not reduce bleeding, whereas on-site monitoring, synthetic antifibrinolytics, and aprotinin require further evaluation in pediatric cardiac surgical patients.
Conclusions:
The use of fresh whole blood to reduce blood loss in children younger than 2 years undergoing complex heart operations is recommended. Therapy for excessive bleeding after cardiopulmonary bypass will vary according to the patient's age, platelet count, and activated partial thromboplastin and prothrombin times.