PREDICTING AND TREATING COAGULOPATHIES AFTER CARDIOPULMONARY BYPASS IN CHILDREN

Coagulopathies in children after cardiopulmonary bypass (CPB) are comp lex. There are very limited data correlating coagulation tests with po stoperative bleeding. We evaluated coagulation changes after CPB and a fter the administration of coagulation products to 75 children. Baseli ne coagulation tests were obtained and repeated after protamine admini stration, after transfusion of individual coagulation products, and on arrival in the intensive care unit (ICU). Regression analysis demonst rated no baseline coagulation test to predict postoperative chest tube drainage. Weight and duration of CPB were determined to be the only p redictors of bleeding. Further analyses demonstrated that children <8 kg had more bleeding and required more coagulation products than child ren >8 kg. Postprotamine platelet count and fibrinogen level correlate d independently with 24-h chest tube drainage in children <8 kg, where as postprotamine platelet count and thrombelastographic values did so in patients weighing >8 kg. Platelet administration alone was found to restore effective hemostasis in many patients. With ongoing bleeding, cryoprecipitate improved coagulation parameters and limited blood los s. Fresh-frozen plasma administration after platelets worsened coagula tion parameters and was associated with greater chest tube drainage an d more coagulation product transfusions in the ICU. Objective data to guide post-CPB component therapy transfusion in children are suggested . Implications: Children <8 kg can be expected to have more severe coa gulopathies, require more coagulation product transfusions, and bleed more after cardiopulmonary bypass. Correlations between coagulation te sts and postoperative chest tube drainage are defined. Platelets and, if necessary, cryoprecipitate optimally restore hemostasis. Fresh-froz en plasma offers no benefits in correcting postcardiopulmonary bypass coagulopathies in children.