The Influence of Cardiopulmonary Bypass Priming without FFP on Postoperative Coagulation and Recovery in Pediatric Patients with Cyanotic Congenital Heart Disease
Transfusion guidelines have been produced for the evidence-based use of
fresh frozen plasma (FFP). However, the inappropriate use of FFP is
still a worldwide problem, especially in the prophylactic settings. In
the present study, 100 cyanotic pediatric patients (age 6 months to
3 years) undergoing cardiac surgery
with cardiopulmonary bypass (CPB) were randomized to receive either
10-20 ml/kg FFP (FFP group, n = 50) or 10-20 ml/kg 4 % succinylated
gelatin (Gelofusine, GEL group, n = 50) in the priming solution. Rapid
thromboelastography (r-TEG) was measured before skin incision and 15 min
after heparin neutralization. Postoperative renal and hepatic function,
mediastinal chest tube drainage, transfusion requirements, and recovery
time were observed. The relationships between hematologic and
demographic data and postoperative bleeding volume were also analyzed.
The results showed that there were significantly elevated levels of
fibrinogen (r-TEG parameters: fibrinogen contribution to maximal
amplitude (MAf) and fibrinogen level (FLEV)) in the FFP group compared
to the GEL group. The postoperative blood loss, total transfusion
requirements, and recovery time were not significantly different between
the two groups, indicating that there were no obvious clinical benefits
of using FFP in the priming. The maximal amplitude (MA) of r-TEG
measured after heparin neutralization was correlated with the 6-h
postoperative bleeding volume. In addition, preoperative fibrinogen
level rather than FFP priming was an independent predictor of
postoperative blood loss. Conclusion: Prophylactic use of FFP in the
priming solution does not have obvious clinical benefits in cyanotic
congenital heart disease (CCHD) patients. Gelofusine, an artificial
colloid, is a safe and effective substitute of FFP in the priming
solution. Furthermore, r-TEG can be used as a “real-time” assessment
tool to evaluate postoperative bleeding and guide transfusion after cardiac surgery in pediatric patients.
