Cardiopulmonary bypass parameters and hemostatic response to cardiopulmonary bypass in infants versus children.
OBJECTIVE
Because infants have relatively more blood loss (mL/kg) than older children during cardiac surgery involving cardiopulmonary bypass (CPB), the authors compared hemostatic activation between infants and older children undergoing cardiac surgery.


METHODS
Observational study.


METHODS
University-affiliated children's hospital.


METHODS
Twenty-eight children (18 infants <1 year and 10 children >1 year) undergoing cardiac surgery with CPB.


METHODS
None.


RESULTS
Markers of coagulation and fibrinolysis were evaluated at 9 sample points before, during, and after CPB in the 28 children. Infants had greater chest tube output, longer CPB times, and a larger drop in platelet counts during CPB than children. Active tissue plasminogen activator (tPA) increased during CPB in both groups, with infants showing lower levels than children (p < 0.001). In both groups, active plasminogen activator inhibitor type 1 (PAI-1) first decreased during CPB and then increased above baseline postoperatively. Infants had higher PAI-1 than children near the end of CPB (p = 0.01). Thrombin-antithrombin complex levels increased during and after CPB, with infants showing lower levels only during CPB (p = 0.01). D-dimer and prothrombin activation peptide (F1.2) levels increased in a similar pattern for both groups during and after CPB. The length of aortic cross-clamp time and the level of F1.2 after protamine administration correlated significantly and independently with 12-hour chest tube output.


CONCLUSIONS
Compared with children, infants had greater blood loss (mL/kg), greater drop in platelets during CPB, lower active tPA, and higher active PAI-1. Cumulative thrombin generation after CPB, indicated by F1.2 levels, correlated with early blood loss.
Eisses
Michael J
MJ
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA. michael.eisses@seattlechildrens.org
Chandler
Wayne L
WL
D000293:Adolescent; D000367:Age Factors; D001777:Blood Coagulation; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D010976:Platelet Count; D013917:Thrombin / Q000378:metabolism; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000097:blood
D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D005344:Fibrinopeptide A; D013917:Thrombin; D010959:Tissue Plasminogen Activator