title: Evidence-based use of FFP: the influence of a priming strategy without FFP during CPB on postoperative coagulation and recovery in pediatric patients.
abstract: OBJECTIVE
  Although fresh frozen plasma (FFP) is one of the most commonly used hemostatic agents in clinical specialties today, there is little evidence available supporting its administration. Our present study observed the effects of a priming strategy without FFP during cardiopulmonary bypass (CPB) on postoperative coagulation and clinical recovery in pediatric patients, aiming to supply new evidence for evidence-based use of FFP.
  
  
  METHODS
  Eighty pediatric patients with congenital heart disease undergoing cardiac surgery with CPB were randomized to receive either 10-20 ml/kg 4% succinylated gelatin (Gelofusine, GEL group, n = 40) or 1-2 units FFP (FFP group, n = 40) in the pump prime. Rapid-thromboelastography (r-TEG) and functional fibrinogen level were measured before skin incision and 15 minutes after heparin reversal. We recorded the volume of chest tube drainage, transfusion requirements and the dosage of pharmacological agents. The ventilation time, ICU length of stay and hospitalization time after surgery were also collected.
  
  
  RESULTS
  After heparin neutralization, there were significantly elevated levels of fibrinogen in the FFP group, which were manifested by r-TEG parameters MAf and FLEV. No significant differences were observed between the two groups in postoperative bleeding, transfusion requirements and the usage of pharmacological agents. Recovery time was also comparable between the two groups.
  
  
  CONCLUSIONS
  In conclusion, prophylactic use of FFP in the priming solution does not provide clinical benefits as presumed. Artificial colloids, such as Gelofusine, can be used safely and effectively as a substitute for FFP in the pump prime. TEG is an effective assessment tool to evaluate postoperative coagulation function in pediatric patients.
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Miao
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China jinpingfw@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: M
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: C
authors.initials: C
authors.lastname: Long
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: F
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: S
authors.initials: S
authors.lastname: Hu
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D016913:Blood Component Transfusion; D002315:Cardiopulmonary Bypass; D019317:Evidence-Based Medicine; D005260:Female; D005780:Gelatin / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010949:Plasma; D011184:Postoperative Period; D013386:Succinates / Q000008:administration & dosage*
chemical_list: D013386:Succinates; C060085:succinylated gelatin; D005780:Gelatin
keywords: blood conservation; cardiopulmonary bypass; coagulation; congenital heart disease; fresh frozen plasma; thromboelastography