Journal article
Authors list: Zajonz, Thomas; Edinger, Fabian; Hofmann, Johannes; Yoerueker, Uygar; Akintuerk, Hakan; Markmann, Melanie; Mueller, Matthias
Publication year: 2024
Journal: The Thoracic and Cardiovascular Surgeon
ISSN: 0171-6425
eISSN: 1439-1902
DOI Link: https://doi.org/10.1055/s-0044-1788931
Publisher: Thieme Publishing / Georg Thieme Verlag
Abstract:
Background Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation algorithm in pediatric cardiac surgery. Methods This single-center, retrospective data analysis included patients younger than 18 years who underwent cardiac surgery with cardiopulmonary bypass (CPB) and received a coagulation therapy according to a predefined POC-controlled coagulation algorithm. Patients were divided into two groups (<10 and >10 kg body weight) because of different CPB priming strategies. Results In total, 173 surgeries with the use of the POC-guided hemostatic therapy were analyzed. In 71% of cases, target parameters were achieved and only in one case primary sternal closure was not possible. Children with a body weight <= 10 kg underwent surgical re-evaluation in 13.2% (15/113), and respectively 6.7% (4/60) in patients >10 kg. Hemorrhage in children <= 10 kg was associated with cyanotic heart defects, deeper intraoperative hypothermia, longer duration of CPB, more complex procedures (RACHS-1 score), and with more intraoperative platelets, and respectively red blood cell concentrate transfusions (all p- values < 0.05). In children <= 10 kg, fibrinogen levels were significantly lower over the 12-hour postoperative period (without revision: 3.1 [2.9-3.3] vs. with revision 2.8 [2.3-3.4]). Hemorrhage in children >10 kg was associated with a longer duration of CPB ( p = 0.042), lower preoperative platelets ( p = 0.026), and over the 12-hour postoperative period lower platelets ( p = 0.002) and fibrinogen ( p = 0.05). Conclusion The use of a preventive, algorithm-based coagulation therapy with factor concentrates after CPB followed by POC created intraoperative clinical stable coagulation status with a subsequent executable thorax closure, although the presented algorithm in its current form is not superior in the reduction of the re-exploration rate compared to equivalent collectives. Reduced fibrinogen concentrations 12 hours after surgery may be associated with an increased incidence of surgical revisions.
Citation Styles
Harvard Citation style: Zajonz, T., Edinger, F., Hofmann, J., Yoerueker, U., Akintuerk, H., Markmann, M., et al. (2024) Evaluation of Point-of-Care-Directed Coagulation Management in Pediatric Cardiac Surgery, The Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0044-1788931
APA Citation style: Zajonz, T., Edinger, F., Hofmann, J., Yoerueker, U., Akintuerk, H., Markmann, M., & Mueller, M. (2024). Evaluation of Point-of-Care-Directed Coagulation Management in Pediatric Cardiac Surgery. The Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0044-1788931
Keywords
ACTIVATED CLOTTING TIME; BLOOD-PRODUCT UTILIZATION; CARDIOPULMONARY BYPASS; COMPLICATIONS; CPB; DOSE HEPARIN; FIBRINOGEN; HEMOSTATIC SYSTEM; HEPCON HMS; Pediatric; THROMBOELASTOMETRY; TRANSFUSION
