Fresh Frozen Plasma in Pump Priming for Congenital Heart Surgery: Evaluation of Effects on Postoperative Coagulation Profiles Using a Fibrinogen Assay and Rotational Thromboelastometry

Lee, Jong Wha; Yoo, Young Chul; Park, Han Ki; Bang, Sou-Ouk; Lee, Ki-Young; Bai, Sun Joon

doi:10.3349/ymj.2013.54.3.752

Cited by 25 publications

(28 citation statements)

References 22 publications

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“…[3][4][5][6][7][8] However, in all those trials except one, 3 the responsible physicians in charge of the patients were not blinded to the allocation group. Moreover, the results of these studies are conflicting with those showing no benefit of a FFP priming strategy, [4][5][6][7] compared with others that are rather in favor of its use. 3,8 We therefore sought to conduct a double-blind trial.…”

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confidence: 99%

Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

et al. 2020

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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.

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confidence: 99%

Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

et al. 2020

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“…61 A prospective randomized controlled trial of infants and children from 1 to 16 years with either 20% albumin (50-100 mL) or FFP (1-2 units) in the pump prime compared hematologic assays and clinical outcomes. 62 While there were improved point-of-care results in the operating room in the FFP group, no clinical differences were noted ≥24 hrs after surgery. Some centers reserve FFP in their pump prime for children <1 month of age to increase fibrinogen levels and reduce blood loss.…”

Section: The Composition Of Cpb Primementioning

confidence: 82%

<p>Minimizing the need for transfusion in pediatric congenital heart surgery</p>

Canêo¹,

Matte²,

Frey³

2019

IJCTM

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Blood conservation has become an essential institutional initiative in cardiac surgery patients secondary to published reports associating transfusion with increased morbidity and mortality. Cardiopulmonary bypass (CPB) for children with congenital heart disease presents unique challenges in regard to transfusion practice. The circuit size relative to the pediatric patient's circulating blood volume results in more hemodilution forcing clinicians to adopt several strategies to counteract this. It is generally agreed that the effects of hemodilution in this population are less well understood. That being said, there is evidence that neurologic outcomes are impacted by significant anemia in neonates and infants undergoing CPB. This adds to the level of concern clinicians should have when managing congenital heart surgery patients. Optimized surgical outcomes are dependent on neurologic outcomes. Specific transfusion guidelines for pediatric cardiac surgery still vary widely across institutions, and a safe minimum hematocrit on bypass has not been established. Evidence-based guidelines are more prevalent in adult cardiac surgery patients, but there are a growing number of reports for pediatrics. Clearly, well-defined operative strategies and a team approach will decrease blood product transfusions and minimize the associated risks in pediatric patients, especially in regard to neurologic outcomes. The ongoing development of evidence-based guidelines for pediatric perfusion will serve clinicians, and most importantly, their patients, well. The purpose of this review is to present current practice to limit blood transfusions in pediatric cardiac surgery exclusively inside the operating room and related to CPB as well as minimizing the side effects of the coagulation disturbances caused by the level of hemodilution these patients may encounter.

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“…FFP transfusion has been associated with increased risk of transfusion‐related adverse reactions, such as transfusion‐associated acute lung injury, transfusion‐transmitted infection, and allergic reaction . Besides, due to the short supply of blood products and the ambiguous efficiency of prophylactic use of FFP, some guidelines have indicated the evidence‐based use of FFP in clinical practice . Therefore, we conducted researches to evaluate the safety and efficiency of priming surgery without FFP.…”

Section: Discussionmentioning

confidence: 99%

Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

Wang

Liu²,

Zou³

et al. 2018

Pediatric Anesthesia

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Fresh Frozen Plasma in Pump Priming for Congenital Heart Surgery: Evaluation of Effects on Postoperative Coagulation Profiles Using a Fibrinogen Assay and Rotational Thromboelastometry

Cited by 25 publications

References 22 publications

Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

<p>Minimizing the need for transfusion in pediatric congenital heart surgery</p>

Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

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