Association of Blood Products Administration During Cardiopulmonary Bypass and Excessive Post-operative Bleeding in Pediatric Cardiac Surgery

AbstractThe majority of children undergoing pediatric cardiac surgery with cardiopulmonary bypass require transfusion of blood products. The management of hemostasis in the pediatric population is challenging, partly due to pronounced alterations in several hemostatic parameters following cardiopulmonary bypass. Despite these marked changes being seen quite often, they are not necessarily an indication for hemostatic interventions. This review summarizes and discusses the available monitoring tests of hemostatic impairment during and following pediatric cardiac surgery. It covers standard laboratory tests, viscoelastic test, evaluation of platelet function, fibrinolysis, and the management of anticoagulation including its reversal. Interpretation of hemostatic measurements is done with due respect to the concept of developmental hemostasis, but also cyanotic heart disease, which are considered by some to be associated with an increased risk of bleeding.

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Systematic Review and Meta-Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Pediatric Anesthesia ◽

10.1111/pan.12560 ◽

2014 ◽

Vol 25 (2) ◽

pp. 135-142 ◽

Cited By ~ 13

Author(s):

Yaoyao Xiong ◽

Yanhua Sun ◽

Bingyang Ji ◽

Jinping Liu ◽

Guyan Wang ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Meta Analysis ◽

Pediatric Cardiac Surgery

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Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002805 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sheila J. Hanson ◽

Oliver Karam ◽

Rebecca Birch ◽

Ruchika Goel ◽

Ravi M. Patel ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pediatric Cardiac Surgery

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Abstract 1667: Early Childhood Mental Development After Transfusion-free Cardiac Surgery On Cardiopulmonary Bypass: A Multi-institutional Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_350 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Tomohiko Ukai ◽

Takenori Adachi ◽

Atsusi Numaguchi ◽

Daichi Fukumi ◽

Toshiaki Yasuda ◽

...

Keyword(s):

Early Childhood ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Brain Dysfunction ◽

Hemoglobin Level ◽

Mental Development ◽

Blood Products ◽

Surgical Closure ◽

Group A ◽

Group B

Background: The use of blood products is often necessary to prime the extracorporeal circuits for pediatric cardiac surgical patients. The use of blood products carries serious risks both in the acute and long-term aspects of patient care. However, excessive hemodilution during cardiopulmonary bypass (CPB) is associated with decreased oxygen carrying capacity, edema, and organ dysfunction. Especially, whether brain dysfunction after transfusion-free cardiac surgery on CPB occurred is unknown. Objective: This study aims to investigate whether excessive hemodilution affects child’s mental development. Methods: We studied 143 infants (24.2 +/− 15.8 months, 5 months ~ 3 years of age) had performed surgical closure of ventricular septal defect (VSD) in less than 12 months (4.8 +/− 2.6 months) of age in 7 children’s hospitals. Questionnaires mailed to the parents included the Tsumori-Inage Infant Developmental Scale estimating subjects’ behavioral developmental level as Developmental Quotients (DQ). The infants were divided into 3 groups; transfusion-free (Group A, n=52), transfusion during CPB (Group B, n=24) and transfusion after CPB (Group C, n=66). Results: Lower DQ was found for Group A (94.7 +/− 11.6) than Group B (103.5 +/− 16.0, p=0.008) and Group C (101.7 +/− 17.9, p=0.016). No correlation was found between DQ and minimum hemoglobin level during CPB (min-Hb) in Group A. The DQ was likely to be lower in the infants with below 6 g/dl (93.0 +/− 13.0) than with over 6 g/dl (98.7 +/− 8.3. p=0.10) of min-Hb. Conclusions: The results suggest that the infants after transfusion-free surgery of VSD on CPB delay in the mental development in their early childhood. Maintaining minimum hemoglobin level over 6 g/dl during CPB seems to prevent the mental development from delay.

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The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

Critical Care of Children with Heart Disease ◽

10.1007/978-3-030-21870-6_10 ◽

2020 ◽

pp. 113-129 ◽

Cited By ~ 4

Author(s):

Ana Maria Manrique ◽

Diana P. Vargas ◽

David Palmer ◽

Kent Kelly ◽

Steven E. Litchenstein

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pediatric Cardiac Surgery

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Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Perfusion ◽

10.1177/0267659120915387 ◽

2020 ◽

Vol 35 (8) ◽

pp. 826-832

Author(s):

Tomomi Hasegawa ◽

Yoshihiro Oshima ◽

Shinji Yokoyama ◽

Asuka Akimoto ◽

Yusuke Misaka ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pilot Study ◽

Interleukin 6 ◽

Patient Characteristics ◽

Serum Levels ◽

Pediatric Cardiac Surgery ◽

Interleukin 8 ◽

Control Group ◽

Platelet Counts

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

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