Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Abstract

Background: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml • kg −1 PlasmaLyte or 15 ml • kg −1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra-and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. results: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml • kg −1 (5.1, 9.4) in the FFP group and 5.7 ml • kg −1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. conclusions: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Protocol Associated with a Decrease in Complications

“…Fresh-frozen plasma, however, has a minimal effect on fibrinogen levels and no effect on the platelet level or function. 22,23 In addition to neurologic and hematologic complications, it is well-known that ECMO frequently results in renal injury. The mechanism of injury is multifactorial, involving a combination of hemodynamic, inflammatory, and microembolic phenomena.…”

Research Priorities for Plasma and Platelet Transfusion Strategies in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

“…Children undergoing cardiac surgery receive large numbers of blood components (19) with postoperative hemostatic transfusions being independently associated with worse clinical outcomes (20). However, priming composition and transfusions during CPB vary across surgeons and institutions with varying results on bleeding (21)(22)(23). Additional research examining risk and benefit of platelet and/or plasma transfusions during the various stages of CPB is necessary to inform intraoperative transfusion decisions making in this patient population.…”

Transfusion Strategies for Hemostatic Blood Products in Critically Ill Children: A Narrative Review and Update on Expert Consensus Guidelines

“…In the setting of CPB, use of whole blood prime versus component therapy and inclusion of plasma and platelets in addition to RBC for the prime are matter of debate, with large variations across institutions. 102 Dilution of circulating coagulation factors and proteins, hypothermia-associated platelet dysfunction, and active bleeding from the surgical field causes many centers to routinely transfuse platelets with the CPB prime and/or when separating from CPB. 103,104 Depending on the degree of surgical hemostasis, coagulopathy, and thrombocytopenia, plasma and platelets are commonly transfused in the highest complexity neonatal and re-do cases in the OR and early postoperative period.…”