Influence of perioperative hypothermia on blood clotting in children

Trčková, Alena; Štourač, Petr

doi:10.4149/bll_2018_055

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Ranucci et al found no significant relationship between those two variables, 16 whereas Bønding Andreasen et al reported that CPB duration correlated significantly with a reduced platelet count and function 14 . Notably, though many studies have shown that coagulation is increasingly impaired with decreasing temperatures, 14,19,20 we found no significant differences in body temperature during CPB between bleeders and nonbleeders. This discrepancy may be explained by the fact that our patients experienced a milder hypothermia for a much shorter period of time.…”

Section: Discussioncontrasting

confidence: 68%

Cardiopulmonary bypass‐induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study

et al. 2021

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Pediatric patients are particularly prone to cardiopulmonary bypass (CPB)-induced coagulopathy mainly due to hemodilution, consumption of coagulation factors and hypothermia. The aim of the present study was to examine the possible role of platelet count and function as it relates to the bleeding risk after CPB in the pediatric population. All consecutive patients (age <13 years) scheduled for elective cardiac surgery between January 2019 and November 2019 were retrospectively considered for the study. We gathered demographic characteristics, perioperative laboratory data (mainly platelet count and function), transfusion requirements, and blood loss for each patient. Patients with a chest tube output during the first 24 hours after surgery >75th percentile were bleeders (cases). Controls were nonbleeders. A total of 31 patients were enrolled [median age 17 (4-57) months]. A significant postoperative

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Section: Discussioncontrasting

confidence: 68%

Cardiopulmonary bypass‐induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study

et al. 2021

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“…1,24-26 Additionally, lower core body temperature in both children and adults undergoing CPB has been correlated with increased coagulopathy. 1,26-28 In our study, children who received rFVIIa had a significantly longer time on CPB and significantly lower core body temperature on CPB when compared with the PCC group. These differences between the two groups may explain why children who received PCC had lower pRBC transfusion rates, lower chest tube output, and less transfusion exposures due to possibly being less coagulopathic than the rFVIIa group.…”

Section: Discussionmentioning

confidence: 50%

Comparison of Prothrombin Complex Concentrate with Activated Factor VII Use for Bleeding Following Cardiopulmonary Bypass in Children

Benson

Hraška

Scott

et al. 2023

World J Pediatr Congenit Heart Surg

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Objective This study aims to compare the efficacy and safety of activated recombinant factor VII (rFVIIa) and prothrombin complex concentrate (PCC) in the treatment of bleeding complications following surgery requiring cardiopulmonary bypass (CPB) in children. Design/Methods This is a retrospective chart review of a single institution comprising patients aged 0 to 18 years old with congenital heart disease. Patients must have received either PCC or rFVIIa after coming off CPB. Our primary efficacy endpoint is time in the operating room from off-CPB to pediatric intensive care unit admission. Our primary safety endpoint is thrombosis through 30 days. Results Our primary efficacy outcome was significantly shorter in the PCC group compared with the rFVIIa group ( P < .0001). Similarly, secondary efficacy outcomes of packed red blood cell administration, chest tube output, and transfusion exposures all significantly favored PCC administration. However, CPB time was significantly longer, and body temperatures were significantly lower, in the rFVIIa group. Safety outcomes, including our primary safety outcome of thrombosis through 30 days, were similar between the two groups. Conclusion This study questions whether PCC could be favored over rFVIIa for hemostasis in children with congenital heart disease following CPB surgery. In addition, this study has found no difference when comparing PCC and rFVIIa in terms of safety outcomes, particularly thrombosis events. There are several limitations to this study due to the retrospective nature of the design and the differences between the two study groups. Despite the limitations, this study suggests that relatively early administration of PCC could be favored over delayed administration of rFVIIa to control recalcitrant post-CPB bleeding in the operating room.

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“…The adverse events of hypothermia are enormous such as thermal discomfort, alterations in pharmacokinetic and pharmacodynamic parameters (essentially muscle relaxants and opiates) ( 27 ), disruption of platelet function, coagulation ( 4 , 28 ) and blood loss, cardiocirculatory and respiratory complications, wound healing delay, and surgical site infections ( 29 ). In neonates and preterm infants, hypothermia can lead to pulmonary hypertension, tissue hypoxia, arterial hypotension and hypoperfusion of vital organs, metabolic acidosis, and hypoglycemia ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative hypothermia, generally defined as a decrease in core temperature below 36°C during surgeries, is one of the most common physiological disturbances during general anesthesia in pediatric patients ( 1 , 2 ). Hypothermia is closely related to postoperative cardiovascular events ( 3 ), coagulopathies ( 4 ), surgical-wound infection ( 5 ), nausea and vomiting ( 6 ), pain ( 7 ), increased blood loss, and prolonged recovery time ( 8 , 9 ). In neonates and infants, cold stress can induce multiple pathophysiological distress such as catecholaminergic response, vasoconstriction, increased metabolism, and decreased lung surfactant synthesis; all these may lead to pulmonary hypertension, tissue hypoxia, arterial hypotension, hypoperfusion metabolic acidosis, and hypoglycaemia ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

Zhao

Chu

et al. 2023

Front. Pediatr.

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ObjectiveThe incidence of intraoperative hypothermia remains high in pediatric patients during anesthesia and surgery even though core body temperature monitoring and warming systems have been greatly improved in recent years. We analyzed the risk factors and outcomes of intraoperative hypothermia in neonates and infants undergoing general anesthesia and surgery.MethodsThe data on the incidence of intraoperative hypothermia, other clinical characteristics, and outcomes from electronic records of 1,091 patients (501 neonates and 590 infants between 28 days and 1 year old), who received general anesthesia and surgery, were harvested and analyzed. Intraoperative hypothermia was defined as a core temperature below 36°C during surgery.ResultsThe incidence of intraoperative hypothermia in neonates was 82.83%, which was extremely higher than in infants (38.31%, p < 0.001)—the same as the lowest body temperature (35.05 ± 0.69°C vs. 35.40 ± 0.68°C, p < 0.001) and the hypothermia duration (86.6 ± 44.5 min vs. 75.0 ± 52.4 min, p < 0.001). Intraoperative hypothermia was associated with prolonged PACU, ICU, hospital stay, postoperative bleeding, and transfusion in either age group. Intraoperative hypothermia in infants was also related to prolonged postoperative extubation time and surgical site infection. After univariate and multivariate analyses, the age (OR = 0.902, p < 0.001), weight (OR = 0.480, p = 0.013), prematurity (OR = 2.793, p = 0.036), surgery time of more than 60 min (OR = 3.743, p < 0.001), prewarming (OR = 0.081, p < 0.001), received >20 mL/kg fluid (OR = 2.938, p = 0.004), and emergency surgery (OR = 2.142, p = 0.019) were associated with hypothermia in neonates. Similar to neonates, age (OR = 0.991, p < 0.001), weight (OR = 0.783, p = 0.019), surgery time >60 min (OR = 2.140, p = 0.017), pre-warming (OR = 0.017, p < 0.001), and receive >20 mL/kg fluid (OR = 3.074, p = 0.001) were relevant factors to intraoperative hypothermia in infants along with the ASA grade (OR = 4.135, p < 0.001).ConclusionThe incidence of intraoperative hypothermia was still high, especially in neonates, with a few detrimental complications. Neonates and infants each have their different risk factors associated with intraoperative hypothermia, but younger age, lower weight, longer surgery time, received more fluid, and no prewarming management were the common risk factors.

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Influence of perioperative hypothermia on blood clotting in children

Abstract: More detailed information on the temperature when the patient is already at risk of developing a clinically significant coagulation disorder and differentiating other factors affecting hemostasis is a subject of further investigation (Tab. 1, Fig. 1, Ref. 20). Text in PDF www.elis.sk.

Cited by 6 publications

References 13 publications

Cardiopulmonary bypass‐induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study

Cardiopulmonary bypass‐induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study

Comparison of Prothrombin Complex Concentrate with Activated Factor VII Use for Bleeding Following Cardiopulmonary Bypass in Children

Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

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