title: Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thromboelastography.
abstract: Complex coagulopathies follow cardiopulmonary bypass (CPB) in children. However, objective laboratory data that can be acquired rapidly to guide their management are lacking. Because thromboelastography has proven useful in this regard, we evaluated the use of celite or tissue factor (TF) activation and heparinase modification of blood samples to allow rapid determination of thromboelastogram data in children younger than 2 yr undergoing CPB. Celite or TF activation shortened the initiation of clotting and, thus, the time required for the important thromboelastogram alpha and maximum amplitude values to begin evolving. Although thromboelastogram alpha and maximum amplitude values were increased with these activators, correlations persisted between platelet count or fibrinogen level and each of these values. The additional use of heparinase allowed thromboelastograms to be obtained during CPB with values not different from those obtained without heparinase after protamine administration. Therefore, celite- or TF-activated, heparinase-modified thromboelastograms begun during CPB allow objective data to be available by the conclusion of protamine administration to help restore hemostasis after CPB in children. Thromboelastography identified transient fibrinolysis during CPB in some children that resolved by the conclusion of protamine administration. Future investigations of the effectiveness of modified thromboelastography-guided coagulopathy management after CPB in children are needed.
  
  
  CONCLUSIONS
  Thromboelastography is useful in assessing the coagulopathies that follow cardiopulmonary bypass in children. Modifying blood samples with celite or tissue factor and heparinase allows thromboelastography begun before the termination of cardiopulmonary bypass to become a rapid point-of-care monitor to provide objective data for guiding blood component therapy to manage these coagulopathies.
authors.affiliation: Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Miller
authors.forename: N A
authors.initials: NA
authors.lastname: Guzzetta
authors.forename: S R
authors.initials: SR
authors.lastname: Tosone
authors.forename: J H
authors.initials: JH
authors.lastname: Levy
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass; D007692:Diatomaceous Earth; D005260:Female; D006490:Hemostatics; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006494:Heparin Antagonists; D019763:Heparin Lyase; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011479:Protamines; D013916:Thrombelastography / Q000379:methods*; D013925:Thromboplastin
chemical_list: D000925:Anticoagulants; D006490:Hemostatics; D006494:Heparin Antagonists; D011479:Protamines; D007692:Diatomaceous Earth; D006493:Heparin; D013925:Thromboplastin; D019763:Heparin Lyase