Cryoprecipitate and platelet administration during modified ultrafiltration in children less than 10 kg undergoing cardiac surgery.
The timing of blood product administration after cardiopulmonary bypass (CPB) may influence the amount of postoperative transfusion and chest tube output. We performed a retrospective study of a novel technique of administering blood products during modified ultrafiltration (MUF) in congenital cardiac surgery. A Control Group (CG; n = 55) received cryoprecipitate and platelets after modified ultrafiltration. The Treatment Group (TG; n = 59) received cryoprecipitate and platelets during MUF. Volumes of blood products transfused in the operating room, initial coagulation parameters in the cardiac intensive care unit, and first 24-hour chest tube output were recorded. Age (116 +/- 198 versus 84 +/- 91 days), weight (4.6 +/- 1.8 versus 4.5 +/- 1.4 kg), duration of bypass (121 +/- 50 versus 139 +/- 57 minutes), and Aristotle scoring (9.3 +/- 2.7 versus 9.1 +/- 3.1) were not significantly different when comparing the control and treatment groups, respectively. Intraoperative packed red blood cells (74.4 +/- 34.8 versus 79.3 +/- 58.0 mL/kg, p = .710), fresh-frozen plasma (58.3 +/- 27.1 versus 59.1 +/- 27.2 mL/kg, p = .849), cryoprecipitate (7.3 +/- 5.1 versus 8.6 +/- 5.9 mL/kg, p = .109), and platelet (19.0 +/- 14.6 versus 23.7 +/- 20.8 mL/kg, p = .176) administration were the same in the control and treatment groups, respectively. However, fibrinogen levels on arrival in the coronary intensive care unit were significantly higher (305 +/- 80 versus 255 +/- 40 mg/dL, p < .001) in the CG compared with the TG. Twenty-four-hour chest tube output was not significantly different but the CG (17.76 +/- 9.34 mL/kg/24 hours) was trending lower than the TG (19.52 +/- 10.94 mL/kg/24 hours, p = .357). In an attempt to minimize CPB-associated bleeding and transfusions, we changed our practice by adjusting the timing of blood product administration after patient separation from CPB. The goals of the change in practice were not measurably different in terms of shorter intraoperative times, fewer blood transfusions, or less chest tube output at our institution.


BACKGROUND
congenital heart disease, modified ultrafiltration, cryoprecipitate, platelets, cardiopulmonary bypass.
Department of Circulatory Support, Children's Hospital Colorado, Aurora, Colorado 80045, USA. Brian.mejak@childrenscolorado.org
Brian L
BL
Mejak
Richard J
RJ
Ing
Craig
C
McRobb
W Cory
WC
Ellis
D Scott
DS
Lawson
Mark D
MD
Twite
James
J
Jaggers
D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000451:nursing* / Q000601:surgery*; D006440:Hemofiltration / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D008297:Male; D017713:Platelet Transfusion / Q000295:instrumentation*
C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen