Fibrinogen in craniosynostosis surgery.
BACKGROUND
During craniosynostosis repair, massive blood loss, consumption and dilution of clotting factors often result in coagulopathy, for which cryoprecipitate, fresh frozen plasma (FFP), and platelets are recommended for treatment. However, cryoprecipitate is not available in most European countries, and the efficacy of FFP in correcting fibrinogen deficiency is limited. We report our experience with human fibrinogen concentrate (Hemocomplettan) used to improve impaired fibrinogen polymerization in children.


METHODS
Results of routine coagulation tests, thrombelastometry (ROTEM), transfusion requirements, administration of fibrinogen concentrate, and data on the postoperative course of nine consecutive children undergoing major craniofacial surgery were retrospectively collected from anesthesia protocols, medical charts, laboratory and ROTEM databases.


RESULTS
The nine children aged 12 (8, 22) mo (median [25th, 75th percentile]), weighing 9.5 (9, 10) kg had a calculated blood loss of 80 (49, 92)% of calculated blood volume during the surgery lasting 6.4 (4.5, 7.2) h. Impaired fibrinogen polymerization detected by ROTEM was the main problem underlying dilutional coagulopathy. In all cases, sufficient hemostasis was achieved without adverse effects by administering (if necessary), repeated doses of fibrinogen concentrates (each single dose 30 mg/kg) without FFP or platelet transfusions. All children were successfully weaned from mechanical ventilation within a few hours and were able to be discharged early from the Intensive Care Unit.


CONCLUSIONS
Administration of fibrinogen concentrate effectively improves fibrinogen polymerization and total clot strength, which were the main underlying problems of dilutional coagulopathy in children undergoing craniosynostosis surgery.
Haas
Thorsten
T
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. thorsten.haas@i-med.ac.at
Fries
Dietmar
D
Velik-Salchner
Corinna
C
Oswald
Elgar
E
Innerhofer
Petra
P
D001777:Blood Coagulation / Q000187:drug effects*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D003398:Craniosynostoses / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003399:Craniotomy; D017707:Erythrocyte Transfusion; D005340:Fibrinogen / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D011994:Recombinant Proteins; D005340:Fibrinogen