Post-operative blood loss following cardio-pulmonary bypass in children

Abstract

Significant post-operative bleeding may occur following cardio-pulmonary bypass, sometimes necessitating early re-exploration. Two questions were asked by this study. Firstly, in children undergoing cardio-pulmonary bypass, can pre-operative, operative and immediately post-operative variables be used to predict post-operative blood loss? Secondly, in the same patient group, can the same variables be used to predict the surgical intervention of re-exploration for excessive bleeding within 12 h of surgery? In a prospective study of patients operated on in a 9-month period, bleeding fell rapidly in the first 3 h after surgery and early re-exploration for bleeding was necessary in 8 of the 206 patients. The only significant predictor of post-operative blood loss was minimum oesophageal temperature, low values being associated with greater blood loss (correlation r = -0.19 (P < 0.05)). With regard to re-exploration for bleeding, a long bypass time (P < 0.05) and abnormal pre-operative coagulation indices (P < 0.01) were significant and independent predictors. The data were also used to create a practical nomogram relating re-exploration for bleeding to hourly post-operative blood loss.

A Pilot Study of Antithrombin Replacement Prior to Cardiopulmonary Bypass in Neonates

“…Its small dimensions (volume 50 mL, weight 140 g) allow intrapericardial placement. HeartWare HVAD use has become increasingly common in the pediatric population; however, only a few reports have already been published (2,3). We describe our experience using the HeartWare HVAD as bridge to cardiac transplantation in our pediatric population consisting of older children and adolescents.…”

“…HeartWare HVAD use has become increasingly common in the pediatric population; however, only a few reports have already been published (2,3). Its small dimensions (volume 50 mL, weight 140 g) allow intrapericardial placement.…”

“…Postoperative blood loss and transfusion of blood products contributes to the morbidity and mortality of children undergoing surgeries requiring cardiopulmonary bypass (CPB) (1)(2)(3). As blood flows across the artificial surfaces of the CPB circuit, platelets and coagulation proteins necessary for hemostasis are activated and consumed.…”

Thromboelastography in the Assessment of Bleeding Following Surgery for Congenital Heart Disease

“…Excessive bleeding in pediatric patients following cardiopulmonary bypass (CPB) surgery occurs frequently 1 –3 and is in part secondary to coagulation derangements from hemodilution and prolonged CPB. 4 –6 Additional risk factors for bleeding in infants and children undergoing CPB include immaturity of the coagulation system, lower body core temperature, repeat sternotomies, and presence of cyanosis.…”

Recombinant factor VIIa (NovoSeven®) as a hemostatic agent after surgery for congenital heart disease

“…Postoperative bleeding and blood product requirements can be substantial in children undergoing open‐heart surgery, reaching 15–110 ml·kg −1 (1), and reexploration is required in 1% of cases (2,3). Bleeding after cardiopulmonary bypass (CPB) is caused mainly by a disturbance in hemostasis induced by the reduction in fibrinogen and coagulation factor activity, thrombocytopenia, and abnormalities in platelet function, complement activation, or fibrinolysis.…”