Coagulation defects in neonates during cardiopulmonary bypass

Kern, Frank H.; Morana, Nicholas J.; Sears, John J.; Hickey, Paul R.

doi:10.1016/0003-4975(93)90073-q

Cited by 34 publications

(4 citation statements)

References 5 publications

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“…23,24 The concentration of both pro- and anti-coagulant factors, including vitamin K-dependent factors II, VII, IX, and X, are reduced after ECMO initiation. 11,25 Additionally, platelet consumption ensues and pro-thrombotic pathways are activated as evidenced by decreased concentrations of fibrinogen and a rise in D-dimers while on ECMO. 26 Blood appears to experience high sheer stress within the ECMO circuit which further depletes circulating factor concentrations and promotes platelet aggregation and thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

Vitamin K and ECMO for neonatal hypoxic respiratory failure

et al. 2021

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Introduction: The objectives of this retrospective cohort study were to examine the effect of vitamin K administration on hemorrhagic and thrombotic complications, blood product utilization, and outcomes in neonatal extracorporeal membrane oxygenation (ECMO). Methods: In the pilot study, complications, blood product use, and outcome data for neonates who received ( n = 21) or did not receive ( n = 18) a single dose of vitamin K (5 mg) immediately after initiation of ECMO for respiratory failure between 2006 and 2010 were compared. In the validation cohort, complications and outcomes were compared for 74 consecutive neonates supported with ECMO for respiratory failure who received ( n = 45) or did not receive ( n = 29) additional vitamin K once daily for prothrombin time (PT) ⩾14 seconds during ECMO from 2014 to 2019. Results: In the pilot study, vitamin K at ECMO initiation was associated with fewer thrombotic complications and similar hemorrhagic complications. The volume of fresh frozen plasma was higher in neonates who received vitamin K, but total blood product and other component volume did not differ between groups. ECMO run time, survival off ECMO, survival to discharge, and length of stay did not differ between cohorts. In the validation cohort, neonates who received additional vitamin K during ECMO had longer ECMO run time and length of stay, but no difference in mortality was observed. Further, thrombotic and hemorrhagic complications as well as blood product exposure were similar between cohorts. Conclusions: These data suggest that routine vitamin K administration may have limited or no benefit during neonatal ECMO.

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Section: Discussionmentioning

confidence: 99%

Vitamin K and ECMO for neonatal hypoxic respiratory failure

et al. 2021

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“…Disturbances of coagulation arise due to factors such as hemostatic system immaturity, hemodilution, systemic inflammation, prolonged bypass time, and the use of deep hypothermic circulatory arrest as well as age-related differences in responses to heparin (9). Children with congenital heart disease, particularly cyanotic polycythemic children, have further derangements of both platelet function and coagulation proteins (6,(32)(33)(34)(35)(36)(37). The physiological impact of CPB during infant surgery exceeds that in adults.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Controlled Trial of Individualized Heparin and Protamine Management in Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Gruenwald

Manlhiot

Chan

et al. 2010

Journal of the American College of Cardiology

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“…Pediatric patients undergoing cardiac surgery may develop coagulopathy after cardiopulmonary bypass (CPB) due to hemodilution and consumption of coagulation factors during CPB [ 1 ]. Previous studies have shown that hypofibrinogenemia increases postoperative blood loss and the need for transfusion of blood products in pediatric cardiac surgery [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Association Between Plasma Fibrinogen Concentration After Cardiopulmonary Bypass and Postoperative Blood Loss in Children Undergoing Cardiac Surgery: A Retrospective Cohort Study

Nishida¹,

Kojima²,

Monteleone³

et al. 2023

Cureus

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Background Intraoperative hypofibrinogenemia is a major factor associated with increased postoperative blood loss in adult cardiac surgery. However, previous pediatric studies on this topic did not sufficiently adjust for potential confounders and variations in surgeons’ techniques. Therefore, evidence for the association between hypofibrinogenemia and postoperative blood loss after cardiac surgery in children remains insufficient. In this study, we aimed to evaluate the association between postoperative blood loss and hypofibrinogenemia by adjusting for potential confounders and the effects of differences in surgeons’ techniques. Methodology This single-center, retrospective, cohort study included children who underwent cardiac surgery with cardiopulmonary bypass from April 2019 to March 2022. Multilevel logistic regression models with mixed effects were used to evaluate the association of major blood loss in the first six hours postoperatively with fibrinogen concentration at the end of cardiopulmonary bypass. The difference in the surgeon’s techniques was adjusted as a random effect for the model. The model included potential confounders identified as risk factors in previous studies. Results A total of 401 patients were included. A fibrinogen concentration ≤150 mg/dL (adjusted odds ratio (aOR) = 2.08; 95% confidence interval (CI) = 1.18-3.67; p = 0.011) and the presence of cyanotic disease (aOR = 2.34; 95% CI = 1.10-4.97; p = 0.027) were associated with major blood loss in the first six postoperative hours. Conclusions A fibrinogen concentration ≤150 mg/dL and the presence of cyanotic disease were associated with postoperative blood loss in pediatric cardiac surgery. Maintaining a fibrinogen concentration >150 mg/dL is recommended, especially for patients with cyanotic diseases.

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Coagulation defects in neonates during cardiopulmonary bypass

Cited by 34 publications

References 5 publications

Vitamin K and ECMO for neonatal hypoxic respiratory failure

Vitamin K and ECMO for neonatal hypoxic respiratory failure

Randomized, Controlled Trial of Individualized Heparin and Protamine Management in Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Association Between Plasma Fibrinogen Concentration After Cardiopulmonary Bypass and Postoperative Blood Loss in Children Undergoing Cardiac Surgery: A Retrospective Cohort Study

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