Evidence-based use of FFP: the influence of a priming strategy without FFP during CPB on postoperative coagulation and recovery in pediatric patients

Miao, Xinyu; Liu, J; Zhao, Ming; Cui, Yongli; Zhao, Feng; Zhao, Jie; Long, Cun; Li, S; Yan, Fuxia; Wang, X; Hu, Shengshou

doi:10.1177/0267659114537328

Cited by 24 publications

(19 citation statements)

References 19 publications

(29 reference statements)

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“…In terms of postoperative kidney dysfunction, no differences were seen in these two groups according to AKIN criteria. Artificial colloid priming did not increase the incidence of postoperative renal injury in low‐weight patients, which was similar to previous studies . As for postoperative recovery parameters and adverse events, the majority were similar between the AC and ACA groups.…”

Section: Discussionsupporting

confidence: 89%

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on‐pump cardiac surgeries

et al. 2019

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Our aim was to explore the effect of two different priming strategies (artificial colloid only vs. artificial colloid combined with human serum albumin) on the prognosis of children weighing less than 5 kg undergoing on‐pump congenital heart disease (CHD) surgery. A total of 65 children weighing less than 5 kg who underwent on‐pump CHD surgery in our hospital from September 2016 to December 2017 were enrolled in this study. The children were randomly divided into two groups: artificial colloid priming group (AC group, n = 33) and artificial colloid combined albumin priming group (ACA group, n = 32). The primary clinical endpoint was the peri‐CPB colloid osmotic pressure (COP). Secondary clinical endpoints included perioperative blood product and hemostatic drug consumption, postoperative renal function, coagulation function, postoperative renal function, and postoperative recovery parameters. COP values were not significant in the priming system as well as peri‐CPB time points between the two groups (P > .05). Platelet consumption in the AC group was significantly lower than that in the ACA group (P < .05). There were no significant differences in the use of other blood products and hemostatic drugs as well as perioperative coagulation parameters between the two groups (P > .05). Postoperative length of stay in the AC group was significantly lower than that in the ACA group (P < .05). There were no significant differences in mortality, postoperative mechanical ventilation time, ICU time, and perioperative adverse events (including postoperative AKI) occurrences between the two groups (P > .05). In the on‐pump cardiac surgeries of patients weighing less than 5 kg, total colloidal priming would not affect peri‐CPB COP values, postoperative coagulation function, and blood products consumption. Total artificial colloidal priming strategy is feasible in low‐weight patients.

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Section: Discussionsupporting

confidence: 89%

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on‐pump cardiac surgeries

et al. 2019

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“…The blood transfusion strategy was improved to limit blood product usage. However, in our previous prospective randomized studies with a small sample size, the use of gelatin as FFP replacement indicated a tendency for decreased blood products while CPB management and transfusion strategy remained unaltered. Therefore, decreased transfusion requirements may be associated with a new priming strategy, which is considered key to the multimodal approach of restrictive transfusion policy in pediatric patients undergoing cardiac surgery .…”

Section: Discussionmentioning

confidence: 89%

“…In our previous prospective study, 80 pediatric patients (aged 6 months to 3 years) were randomly divided into different priming strategy groups for thromboelastographic measurements. Although values of MAf, FLEV in the FFP group were increased, indicating higher level of clotting factors and fibrinogen, postoperative bleeding and transfusion were comparable, indicating the absence of tangible clinical benefit …”

Section: Discussionmentioning

confidence: 91%

“…Gelatins differ from other nonprotein colloids due to the absence of dose limitation, without any accumulation in the body and therefore, associated with few adverse effects . In our prospective randomized controlled trials, 100 cyanotic pediatric patients (aged 6 months to 3 years) and 80 pediatric patients (aged less than 3 years) undergoing cardiac surgery were randomly divided into plasma and gelatin groups with different priming strategies. The postoperative coagulation and recovery indicators in both groups were comparable, which prompted our center to substitute succinylated gelatin for FFP in pediatric cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

Wang

Liu²,

Zou³

et al. 2018

Pediatric Anesthesia

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“…The administration of fibrinogen concentrate during closure time in our institution was mainly based upon the discretion of surgeon and anesthesiologist for patients with severe cyanosis or whom undergoing complex surgery with prolonged CPB. After returning to ICU, fibrinogen concentrate was administered either independently to the patients with moderate bleeding or accompanied with FFP to those excessively bleeding patients, with a dosage of 0.5 g for infants weighted between 5 and 15 kg [6]. However, the clinical experience of fibrinogen concentrate in pediatric patients is limited.…”

mentioning

confidence: 99%

Reply to “No evidence to support a priming strategy with FFP in infants”

Miao

Liu

2014

Eur J Pediatr

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To the editor: We would like to thank Faraoni et al. for their letter in response to our paper [5]. The letter is a good opportunity to provide additional information on the rational use of fresh frozen plasma (FFP) as well as fibrinogen concentrate in the pediatric population. We agree with their comments on the following two aspects.For one, there is no evidence to support the systematic administration of FFP in pediatric patients, especially in children older than 6 months. However, the addition of FFP in the priming solution is still a common practice during pediatric cardiopulmonary bypass (CPB) today, may be not just in our country. In addition to the blood shortage, the inappropriate use of FFP could lead to unnecessary donor exposure and cause a variety of adverse clinical consequences. Thus, more specific researches focus upon this kind of patients, including children older than 6 months, are still in urgent need. For neonates and infants aged between 1 and 6 months, the evidence of using FFP is poor and we also not support to use FFP in the pump prime. Indeed, neonates undergoing arterial switch operation with CPB in our institution had been just primed with red blood cell, albumin, and artificial colloid solution (20 ml/kg) in recent 2 years. No safety concerns, such as abnormal bleeding, increased transfusion requirements, and mortality, were observed during our almost 2 years of clinical practice. The suggestion of defining the benefit-to-risk balance of a priming strategy with FFP in neonates will be included in our ongoing studies. We will further evaluate the coagulation function in these patients by using thromboelastography (TEG). Moreover, the more extensive study across a larger cohort of patients should be carried out in order to supply acceptable level of evidence regarding priming with FFP in neonates.For the other, we agree with Faraoni and colleagues that fibrinogen concentrate supplementation could be effective in preventing and treating postoperative blood loss. In our previous studies, we had observed that fibrinogen concentrate could be an effective substitute for FFP and its administration guided by TEG was associated with decreased postoperative blood loss and improved prognosis for severe cyanotic patients with complex congenital heart disease [1, 2]. Faraoni and colleagues study supplied an important finding that a cut-off value of 1.50 g l −1 for plasma fibrinogen concentration measured by the Clauss method or a cut-off of 3 mm for MCF on FIBTEM was predictive of significantly postoperative bleeding [3,4]. Our study also showed that the preoperative FLEV value was independently associated with postoperative blood loss. The administration of fibrinogen concentrate during closure time in our institution was mainly based upon the discretion of surgeon and anesthesiologist for patients with severe cyanosis or whom undergoing complex surgery with prolonged CPB. After returning to ICU, fibrinogen concentrate was administered either independently to the patients with moderate bleeding o...

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Evidence-based use of FFP: the influence of a priming strategy without FFP during CPB on postoperative coagulation and recovery in pediatric patients

Cited by 24 publications

References 19 publications

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on‐pump cardiac surgeries

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on‐pump cardiac surgeries

Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

Reply to “No evidence to support a priming strategy with FFP in infants”

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