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Point of care testing in children undergoing cardiopulmonary bypass
Author(s) -
TiroshWagner Tal,
Strauss Tzipi,
Rubinshtein Marina,
Tamarin Ilia,
Mishaly David,
Paret Gideon,
Kenet Gili
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22803
Subject(s) - medicine , cardiopulmonary bypass , partial thromboplastin time , perioperative , prothrombin time , thromboelastometry , coagulation testing , anesthesia , fresh frozen plasma , blood product , activated clotting time , clotting time , surgery , fibrinogen , coagulation , platelet , coagulopathy
Background Excessive hemorrhage is a major complication after cardiac surgery requiring cardiopulmonary bypass (CPB). The aim of this study was to define the potential role of the cone and platelet analyzer (CPA) and the rotating thromboelastogram (ROTEM) point of care tests in children undergoing CPB. Procedure We prospectively studied 15 pediatric patients aged 1 month to 10 years. Blood count, blood coagulation tests (prothrombin time [PT], activated partial thromboplastin time, fibrinogen, thrombin time), CPA and ROTEM parameters were measured before and after CPB. Demographic and surgical data were recorded as were those on perioperative blood loss and blood product transfusion. Results Low body weight, longer duration on CPB and lower core body temperature were associated with an increased bleeding risk. The ROTEM test showed a significant prolongation of clotting time and decreased maximal clot firmness (MCF) postoperatively in children with increased bleeding. The coagulation parameters associated with increased bleeding were: prolonged PT, lower fibrinogen levels, prior to surgery, and lower MCF after surgery. CPA test findings were not associated with postoperative bleeding in our patients. Conclusions CPA did not serve as a prognostic tool for predicting bleeding risk in children undergoing CPB. The change in ROTEM's post‐CPB results associated with bleeding tendency, and they may predict for poorer clot formation and stability. Pediatr Blood Cancer 2011;56:794–798. © 2010 Wiley‐Liss, Inc.