Understanding and managing the complex balance between bleeding and thrombosis following cardiopulmonary bypass in paediatric cardiac surgical patients

Abstract

Bleeding in the perioperative period of congenital heart surgery with cardiopulmonary bypass is associated with increased morbidity and mortality both from the direct effects of haemorrhage as well as the therapies deployed to restore haemostasis. Perioperative bleeding is complex and multifactorial with both patient and procedural contributions. Moreover, neonates and infants are especially at risk. The objective of this review is to summarise the evidence regarding bleeding management in paediatric surgical patients and identify strategies that might facilitate appropriate bleeding management while minimising the risk of thrombosis. We will address the use of standard and point-of-care tests, and the role of contemporary coagulation factors and other novel drugs.

The Year in Review: Anesthesia for Congenital Heart Disease 2021

“…Point of care viscoelastic testing using thromboelastography (TEG) or rotational thromboelastography (ROTEM) has shown promise in decreasing unnecessary transfusion of blood products by providing qualitative information regarding clot formation and stability. 30 While these tests can help distinguish between coagulopathy and inadequate surgical hemostasis, the tests take up to 30-45 minutes to complete, and the results may lag behind the need to make immediate clinical decisions. Visual assessment of the surgical field is often used to guide initial transfusion decisions, but visual inspection may not reliably distinguish between surgical and coagulopathic bleeding and may lead to excessive and inappropriate transfusion.…”