Epsilon aminocaproic acid in paediatric cardiac surgery to reduce postoperative blood loss

We have studied the efficacy of epsilon aminocaproic acid in reducing posto perative blood loss in infants and children with congenital cyanotic cardia c anomalies undergoing corrective operative procedures. This prospective st udy was carried out on 170 infants and children randomly divided into two e qual groups. Group A acted as the control group and received normal saline as placebo while group B patients received epsilon aminocaproic acid (100 m g/kg body wt) intravenously slowly soon after anaesthetic induction followe d by 100 mg/kg in the cardiopulmonary bypass pump at the time of starting o f cardiopulmonary bypass and 100 mg/kg after weaning from bypass over a per iod of 3 h. In group A the time for sternal closure after separation from b ypass and administration of protamine was 75.18 +/- 5.5 min and in group B 50.7 +/- 5.2, (P<0.001). Blood loss at 24 h in group A was 42.6 +/- 6.9 ml/ kg/24 h and in group B 23.7 +/- 5.8 ml/kg/24 h, (P<0.001). The need for pac ked red cells in group A was 21.8 +/- 7.1 ml/kg/24 h and in group B 10.7 +/ - 7.8 ml/kg/24 h, (P<0.001). The need for platelet concentrate in group A w as 22.0 +/- 6.7 ml/kg/24 h and group B 6.2 +/- 3.2 ml/kg/24 h, (P<0.001). F ibrin degradation products (split) in group A was 8.2 +/- 0.8 mu g/ml, and group B 3.8 +/- 1.3 mu g/ml, (P<0.001). Reexploration rate was also conside rably reduced in group B, 5 of 85 (6%) compared to group A, 13 of 85 (15%), (P<0.001). It was found that epsilon aminocaproic acid is effective in red ucing postoperative blood loss, packed red cells and plasma product require ments in paediatric patients undergoing corrective surgical procedures for congenital cyanotic heart diseases.