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Fibrinolysis in pediatric patients undergoing cardiopulmonary bypass
G D Williams1, S L Bratton, N J Nielsen
1Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Insights
Fibrinolysis during pediatric cardiac surgery cardiopulmonary bypass (CPB) was identified in 16% of children. This fibrinolysis did not significantly impact blood loss or blood product transfusions in these young patients undergoing complex procedures.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis and Thrombosis
- Coagulation Monitoring
Background:
- Fibrinolysis, a critical component of hemostasis, plays a significant role in blood loss during surgical procedures.
- Understanding the impact of fibrinolysis in pediatric cardiac surgery is essential for optimizing patient outcomes and transfusion strategies.
Purpose of the Study:
- To evaluate the influence of fibrinolysis on perioperative blood loss and blood product requirements in children undergoing cardiac surgery.
- To identify risk factors and characteristics associated with fibrinolysis during cardiopulmonary bypass (CPB).
Main Methods:
- A prospective study involving 278 children undergoing cardiac surgery.
- Coagulation status was assessed using native and protamine-modified thromboelastography (TEG) before, during, and after CPB.
- Perioperative blood loss and blood product transfusions were meticulously recorded.
Main Results:
- Fibrinolysis (defined as A30/MA < 0.85) was observed in 16% of children during CPB, particularly in younger children undergoing complex, prolonged surgeries with deep hypothermia.
- Fibrinolysis before CPB was associated with poor cardiac output.
- Despite the presence of fibrinolysis during CPB, these patients did not experience significantly greater blood loss or require more blood products compared to non-fibrinolytic controls.
Conclusions:
- A specific cohort of pediatric patients at risk for fibrinolysis during CPB was identified.
- Fibrinolysis occurring during CPB in children does not appear to be a significant independent predictor of increased blood loss or transfusion needs.
Objective:
Thromboelastographic evaluation of the influence of fibrinolysis on blood loss and blood product transfusions in children during cardiac surgery.
Design:
Prospective study.
Setting:
University-affiliated, pediatric medical center.
Participants:
Two hundred seventy-eight consecutive children undergoing cardiac surgery.
Interventions:
Blood sampling for coagulation tests, including native and protamine-modified thromboelastography.
Measurements And Main Results:
Blood coagulation tests were measured before, during, and after cardiopulmonary bypass (CPB). Demographic data, perioperative blood loss, and blood product transfusions were prospectively recorded. Fibrinolysis was defined as thromboelastography of A30/MA less than 0.85 (MA, maximum amplitude; A30, amplitude 30 minutes after MA) and was noted in 3% of children pre-CPB, 16% during CPB, and 3% post-CPB. Fibrinolysis before CPB was associated with poor cardiac output. Fibrinolysis during CPB occurred in young children (aged 350 +/- 836 days) undergoing complex surgery with prolonged CPB (119 +/- 48.8 minutes) and deep hypothermia (25.6 degrees C +/- 4.7 degrees C). These patients received blood products after CPB and were not fibrinolytic after transfusion. They incurred similar blood loss (in mL/kg) and received similar volumes of blood products (mL/kg) as age-matched and surgery-matched patients without fibrinolysis.
Conclusion:
A group of children at risk for fibrinolysis during CPB was identified. However, fibrinolysis during CPB did not influence blood loss or the total volume of blood products transfused.