Con: Routine Use of Fresh Frozen Plasma Should Not Be Used to Prime Cardiopulmonary Bypass Circuits During Cardiac Surgery

Bleeding is a well-documented and frequently encountered complication after cardiac surgery, affecting roughly 2%-to-10% of all patients. Major bleeding is a known risk factor for significant morbidity and mortality after complex cardiac surgery such as aortic surgery, left ventricular assist device implantation, redo sternotomy, and transplant. The definition of major hemorrhage remains controversial; however, most agree that bleeding requiring reoperation, transfusion, or significant decreases in hemoglobin should qualify. Numerous prophylactic agents have been studied for the reduction of bleeding and/or the need for transfusion. In this review, the authors examine the use of fresh frozen plasma (FFP) for priming the cardiopulmonary bypass (CPB) circuit and discuss the lack of evidence supporting its routine use in this population.