Use of Blood Products in Pediatric Cardiac Surgery

OBJECTIVES Postoperative bleeding is a common cause of morbidity and mortality in cardiac patients who undergo cardiopulmonary bypass (CPB). Pediatric patients are especially at risk for adverse effects of surgery and CPB on the coagulation system. This can result in bleeding, transfusions, and poor outcomes. Excessive bleeding unresponsive to blood products can warrant the off-label use of recombinant activated clotting factor VIIa (rFVIIa) and/or anti-inhibitor coagulant complex (FEIBA). Several studies have shown the utility in these agents off-label in patients who have undergone cardiac bypass surgery with acute bleeding episodes that are refractory to blood products. However, data regarding use of these agents in pediatrics are sparse. The purpose of this study is to report the use of rFVIIa and FEIBA in pediatric cardiac surgery patients in our institution. METHODS This was a retrospective chart review of pediatric cardiothoracic surgery patients who received rFVIIa or FEIBA at Children's Healthcare of Atlanta during the study period. RESULTS Thirty-three patients received rFVIIa and 9 patients received FEIBA either intraoperatively or postoperatively for bleeding related to the cardiac procedure. Approximately 13% of rFVIIa patients and 55% of FEIBA patients required repeat doses. There were decreases for all blood products administered after rFVIIa and FEIBA were given. However, the doses used did not correlate with either positive or negative outcomes. Seventeen percent (n = 7) of rFVIIa patients experienced a thrombus and 22% (n = 2) of FEIBA patients experienced a thrombus. CONCLUSIONS Both rFVIIa and FEIBA reduced blood product usage in pediatric patients following cardiac procedures.

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Hemostasis in Pediatric Cardiac Surgery

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1603365 ◽

2017 ◽

Vol 43 (07) ◽

pp. 682-690

Author(s):

Hanne Ravn

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pediatric Population ◽

Pediatric Cardiac Surgery ◽

Test Evaluation ◽

Cyanotic Heart Disease ◽

Standard Laboratory ◽

Blood Products ◽

Risk Of Bleeding ◽

Increased Risk

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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Bloodless cardiac surgery and the pediatric patient: a case study

Perfusion ◽

10.1177/0267659108095903 ◽

2008 ◽

Vol 23 (2) ◽

pp. 131-134 ◽

Cited By ~ 11

Author(s):

AL Ging ◽

JR St. Onge ◽

DC Fitzgerald ◽

LR Collazo ◽

LS Bower ◽

...

Keyword(s):

Cardiac Surgery ◽

Near Infrared ◽

Cell Mass ◽

Male Infant ◽

Pediatric Cardiac Surgery ◽

Blood Products ◽

Homologous Blood ◽

Circulating Blood Volume ◽

Homologous Blood Transfusion ◽

Priming Volume

Peri-operative transfusion of blood or blood products is associated with increased morbidity and mortality after cardiac surgery. However, excessive hemodilution as a result of avoiding the use of homologous blood products can also lead to decreased oxygen delivery to vital end organs and dilutional coagulopathy. This is particularly challenging in pediatric cardiac surgery where there is a large discrepancy between the patient circulating blood volume and the priming volume of the cardiopulmonary bypass (CPB) circuit. Strategies to avoid the use of homologous blood products during pediatric cardiac surgery must also incorporate miniaturization of the CPB circuit and other bypass techniques in order to avoid problems with excessive hemodilution. We report a 5.9 kg male infant who underwent successful surgical correction of a ventricular septal defect without the use of homologous blood transfusion. Our strategies included the pre-operative administration of erythropoietin and iron to increase red blood cell mass, acute normovolemic hemodilution (ANH) before the institution of CPB, retrograde autologous priming (RAP), cell salvage, continuous ultrafiltration, vacuum-assisted venous drainage to minimize the circuit size and priming volume, and the use of near infrared spectroscopy (NIRS) to monitor the patient during the entire procedure. The utilization of these strategies is now standard for our entire pediatric cardiac surgical population.

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