Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thromboelastography

Complex coagulopathies follow cardiopulmonary bypass (CFB) in children. How ever, objective laboratory data that can be acquired rapidly to guide their management are lacking. Because thromboelastography has proven useful in t his regard, we evaluated the use of celite or tissue factor (TF) activation and heparinase modification of blood samples to allow rapid determination of thromboelastogram data in children younger than 2 yr undergoing CPB. Cel ite or TF activation shortened the initiation of clotting and, thus, the ti me required for the important thromboelastogram alpha and maximum amplitude values to begin evolving. Although thromboelastogram ct and maximum amplit ude values were increased with these activators, correlations persisted bet ween platelet count or fibrinogen level and each of these values. The addit ional use of heparinase allowed thromboelastograms to be obtained during CP B with values not different from those obtained without heparinase after pr otamine administration. Therefore, celite- or TF-activated, heparinase-modi fied thromboelastograms begun during CPB allow objective data to be availab le by the conclusion of protamine administration to help restore hemostasis after CPB in children. Thromboelastography identified transient fibrinolys is during CPB in some children that resolved by the conclusion of protamine administration. Future investigations of the effectiveness of modified thr omboelastography-guided coagulopathy management after CPB in children are n eeded.