Association Between Platelet Count and Postoperative Blood Loss in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass and Fresh Frozen Plasma Administration Guided by Thromboelastometry

Objective(s): Modified ultrafiltration has gained wide acceptance as a powerful tool against cardiopulmonary bypass morbidity in pediatric cardiac surgery. The aim of our study was to assess the importance of modified ultrafiltration within conditions of contemporary cardiopulmonary bypass characteristics. Methods: Ninety–eight patients (overall cohort) weighing less than 12 kg undergoing surgical repair with cardiopulmonary bypass were prospectively enrolled in a randomized protocol to receive modified and conventional ultrafiltration (MUF group) or just conventional ultrafiltration (non-MUF group). A special attention was paid to forty-nine neonates and infants weighing less than 5 kg (lower weight (LW) cohort). Results: Post-filtration hematocrit was significantly higher in the MUF group for both cohorts (overall cohort p = 0.001; LW cohort p = 0.04), but not at other time points. During the postoperative course, patients in the MUF group received fewer packed red blood cells, (overall cohort p = 0.01; LW cohort p = 0.07), but required more fresh frozen plasma (overall cohort p = 0.04; LW cohort p = 0.05). There was no difference between groups in hemodynamic state, chest tube output, duration of mechanical ventilation, respiratory parameters, duration of intensive care unit, and hospitalization stay. Conclusions: If conventional ultrafiltration provides adequate hemoconcentration modified ultrafiltration does not provide additional positive benefits except for reduction in blood cell transfusion, This, however, comes at the cost of needing more fresh frozen plasma. Of particular importance is that this also applies to infants with weight bellow 5 kg where modified ultrafiltration was supposed to have the greatest positive impact.

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Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Anesthesiology ◽

10.1097/aln.0000000000003017 ◽

2020 ◽

Vol 132 (1) ◽

pp. 95-106 ◽

Cited By ~ 5

Author(s):

Audrey Dieu ◽

Maria Rosal Martins ◽

Stephane Eeckhoudt ◽

Amine Matta ◽

David Kahn ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Postoperative Bleeding ◽

Fresh Frozen Plasma ◽

Postoperative Blood Loss ◽

Blood Product Transfusion ◽

Blood Products ◽

Packed Red Blood Cells ◽

Number Of Patients ◽

Fresh Frozen ◽

Frozen Plasma

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. Results Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg−1 (5.1, 9.4) in the FFP group and 5.7 ml · kg−1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. Conclusions The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

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Con: Routine use of fresh frozen plasma should not be used to prime cardiopulmonary bypass circuits during cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.05.022 ◽

2021 ◽

Author(s):

Meena Bhatia ◽

Priya A. Kumar

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma

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FAILURE OF FRESH FROZEN PLASMA TO REDUCE BLOOD LOSS AND BLOOD REPLACEMENT AFTER CARDIOPULMONARY BYPASS

Anesthesia & Analgesia ◽

10.1213/00000539-198802001-00190 ◽

1988 ◽

Vol 67 (Supplement) ◽

pp. 190 ◽

Cited By ~ 1

Author(s):

R C Roy ◽

M A Stafford ◽

A S Hudspeth ◽

J W Meredith

Keyword(s):

Cardiopulmonary Bypass ◽

Blood Loss ◽

Fresh Frozen Plasma ◽

Reduce Blood Loss ◽

Blood Replacement ◽

Fresh Frozen ◽

Frozen Plasma

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Fresh-frozen plasma transfusion did not reduce 30-day mortality in patients undergoing cardiopulmonary bypass cardiac surgery with excessive bleeding: the PLASMACARD multicenter cohort study

Transfusion ◽

10.1111/trf.12422 ◽

2013 ◽

Vol 54 (4) ◽

pp. 1114-1124 ◽

Cited By ~ 8

Author(s):

Adélaïde Doussau ◽

Paul Perez ◽

Maryse Puntous ◽

Joachim Calderon ◽

Michel Jeanne ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Cardiopulmonary Bypass ◽

Fresh Frozen Plasma ◽

Plasma Transfusion ◽

Multicenter Cohort Study ◽

Excessive Bleeding ◽

Multicenter Cohort ◽

Fresh Frozen ◽

Frozen Plasma

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A Phase III, Double-blind, Placebo-controlled, Multicenter Study on the Efficacy of Recombinant Human Antithrombin in Heparin-resistant Patients Scheduled to Undergo Cardiac Surgery Necessitating Cardiopulmonary Bypass

Anesthesiology ◽

10.1097/00000542-200502000-00007 ◽

2005 ◽

Vol 102 (2) ◽

pp. 276-284 ◽

Cited By ~ 83

Author(s):

Michael S. Avidan ◽

Jerrold H. Levy ◽

Jens Scholz ◽

Elise Delphin ◽

Peter M. J. Rosseel ◽

...

Keyword(s):

Cardiac Surgery ◽

Placebo Group ◽

Cardiopulmonary Bypass ◽

Fresh Frozen Plasma ◽

Clotting Time ◽

Double Blind ◽

Double Blind Placebo ◽

Activated Clotting Time ◽

Fresh Frozen ◽

Frozen Plasma

Background The study evaluated the efficacy of recombinant human antithrombin (rhAT) for restoring heparin responsiveness in heparin resistant patients undergoing cardiac surgery. Methods This was a multicenter, randomized, double-blind, placebo-controlled study in heparin-resistant patients undergoing cardiac surgery with cardiopulmonary bypass. Heparin resistance was diagnosed when the activated clotting time was less than 480 s after 400 U/kg heparin. Fifty-four heparin-resistant patients were randomized. One cohort received 75 U/kg rhAT, and the other received normal saline. If the activated clotting time remained less than 480 s, this was considered treatment failure, and 2 units fresh frozen plasma was transfused. Patients were monitored for adverse events. Results Only 19% of patients in the rhAT group received fresh frozen plasma, compared with 81% of patients in the placebo group (P < 0.001). During their hospitalization, 48% of patients in the rhAT group received fresh frozen plasma, compared with 85% of patients in the placebo group (P = 0.009). Patients in the placebo group required higher heparin doses (P < 0.005) for anticoagulation. There was no increase in serious adverse events associated with rhAT. There was increased blood loss 12 h postoperatively (P = 0.05) with a trend toward increased 24-h bleeding in the rhAT group (P = 0.06). There was no difference between the groups in blood and platelet transfusions. Conclusion Treatment with 75 U/kg rhAT is effective in restoring heparin responsiveness and promoting therapeutic anticoagulation in the majority of heparin-resistant patients. Treating heparin-resistant patients with rhAT may decrease the requirement for heparin and fresh frozen plasma.

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