title: Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS.
abstract: OBJECTIVE
  There is limited literature documenting bleeding patterns in pediatric post-cardiotomy patients on extracorporeal life support (ECLS). This retrospective review details bleeding complications and identifies risk factors for bleeding in these patients.
  
  
  METHODS
  Records from 145 patients were reviewed. Patients were divided into excessive (E) and non-excessive (NE) bleeding groups based on blood loss.
  
  
  RESULTS
  Excessive bleeding occurred predominantly from 0-6h. Longer CPB duration (NE=174+/-8 min; E=212+/-16; p=0.02) and lower platelet counts (NE=104.8+/-50K; E=84.3+/-41K; p=0.01) were associated with excessive bleeding during the first 6h (p=0.005). Use of intraoperative protamine with normal platelets was associated with decreased bleeding from 7-12 h post-ECLS (p=0.002). Most mediastinal exploration occurred > 49 h post-ECLS, with decreased bleeding post-exploration in E patients.
  
  
  CONCLUSIONS
  The majority of pediatric post-cardiotomy ECLS bleeding occurs early after support initiation. Longer CPB time and thrombocytopenia increased bleeding 0-6h post-ECLS. Since early bleeding may be coagulopathic in origin, an approach to minimize bleeding includes protamine administration and aggressive blood product replacement with target platelet counts of 100-120K. Surgical exploration should follow if additional hemostasis is necessary.
authors.affiliation: Departments of Pediatric (Cardiology), University of Michigan Health Systems, Ann Arbor, MI, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nardell
authors.forename: Gail M
authors.initials: GM
authors.lastname: Annich
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch
authors.forename: Cathe
authors.initials: C
authors.lastname: Fahrner
authors.forename: Pat
authors.initials: P
authors.lastname: Brownlee
authors.forename: Karen
authors.initials: K
authors.lastname: King
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Fleming
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gajarski
mesh_terms: D022561:Advanced Cardiac Life Support; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation; D006331:Heart Diseases / Q000151:congenital / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000601:surgery*