Identification of a thromboelastographic pattern in children undergoing cardiac surgery with prolonged exposure to cardiopulmonary bypass☆

  • Orlando J. Tamariz-Cruz Cardiovascular Anaesthesia, Cardiovascular Surgery Division, Instituto Nacional de Pediatría, KARDIAS/CMABC, Mexico City, Mexico
  • Silvia Cruz-Sánchez Paediatric Anaesthesia, Surgery Department, Instituto Nacional de Pediatría, Mexico City, Mexico
  • Carolina Pérez-Pradilla Anaesthesia Department, Instituto Roosevelt de Ortopedia Infantil, Bogotá D.C., Colombia
  • Luis G. Motta-Amézquita Cardiovascular Anaesthesia, Cardiovascular Surgery Division, Instituto Nacional de Pediatría, KARDIAS/CMABC, Mexico City, Mexico
  • Hector Díliz-Nava Cardiovascular Surgery Division, Instituto Nacional de Pediatría, KARDIAS/CMABC, Mexico City, Mexico
  • Alexis Palacios-Macedo-Quenot Cardiovascular Surgery Division, Instituto Nacional de Pediatría, KARDIAS/CMABC, Mexico City, Mexico
DOI: https://doi.org/10.1016/j.rcae.2016.12.006
Keywords: Thrombelastography, Thoracic surgery, Hemorrhage, Child, Blood Coagulation
Abstract References How to Cite Downloads

Abstract

Background: Point-of-care thromboelastography is used for guiding peri-operative haemostatic therapy.

Objective: To identify a thromboelastographic pattern in children with prolonged cardiopulmonary bypass exposure.

Material and methods: A cohort study of 62 patients undergoing prolonged cardiopulmonary bypass was performed. Patients with preexisting coagulopathy, use of drugs known to interfere with clotting, hematocrit > 60%, weight < 3 kg, or hepatic disease were excluded. The thromboelastography study was conducted at the point of care.

Results: Baseline and rewarming reaction time values were 8.24 ± 6.35 and 7.66 ± 2.15min, respectively (p = 0.102). Baseline and rewarming angle values were 64.88 ± 13.08 and 54.67 ± 8.98 degrees, respectively (p < 0.001). Baseline and rewarming maximum amplitude values were 64.54 ± 12.31 and 43.14 ± 12.47 mm, respectively (p = 0.001). The same trend was observed when the cohort was divided into patients under and over 3 years of age, and patients under and over 10 kg of body weight.

Discussion: This study suggests the existence of a thromboelastographic pattern independent of age or weight in patients undergoing paediatric cardiac surgery with prolonged cardiopulmonary bypass exposure, characterised by a reduction of angle and maximum amplitude values, with no change in reaction time.

References

1. Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss products and blood product transfusions: a multivariate analysis in children undergoing cardiac surgery. Anesth Analg. 1999;89:57-64.
2. Dixon B, Santamaria J, Campbell D. Coagulation activation and organ dysfunction following cardiac surgery. Chest. 2005;128:229-36.
3. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CAA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding. Guidelines form the European Society of Anesthesiology. Eur J Anaesthesiol. 2013;30:270-82.
4. ASA Task Force on Perioperatve Blood Management. Practice guidelines for perioperative blood management. Anesthesiology. 2015;122:241-75.
5. Salis S, Mazzanti V, Maerli G, Salvi L, Calogero CT, Veglia F, et al. Cardiopulmonary bypass is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:814-22.
6. Jenkins K, Gauvreau J, Newburger J, Spray TL, Moller JH, Lezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123:110-8.
7. Niebler RA, Gill JC, Brabant CP, Mitchell ME, Nugent M, Simpson P, et al. Thromboelastograph in the assessment of bleeding following surgery for congenital heart disease. World J Pediatr Congenit Heart Surg. 2012;3:433-8.
8. Pekelharing J, Furk A, Banya W, Macrae D, Davidson SJ. Comparison between thromboelastography and conventional coagulation tests after cardiopulmonary bypass surgery in the pediatric intensive care unit. Int J Lab Hem. 2014;36:465-71.
9. Latham GJ, Eisses MJ, Bender MA, Haberkern CM. Essentials of hematology. In: Coté CJ, Lerman J, Tobres D, editors. A practice of anesthesia for infants and children. 5th ed. Philadelphia, PA: Elsevier Saunders Inc; 2013. p. 178-97.
10. Jain K, Singh SD, Mukerjee DP. Observations on thromboelastographic patterns and coagulation changes in malnutrition (marasmus and kwashiorkor) Indian Pediatr. 1979;16:1115-9.
11. Miller BE, Mochizuki T, Levy JH. Predicting and treating coagulopathies after CPB in children. Anesth Analg. 1997;85:1196-202.
12. Chan KL, Summerhayes RG, Ignjatovic V, Horton SB, Monagle PTL. Reference values for kaolin-activated thromboelastography in healthy children. Anesth Analg. 2007;105:1610-3.
13. Miao X, Liu J, Zhao M, Cui Y,Feng Z, Zhao J, et al. The influence of cardiopulmonary bypass priming without FFP on postoperative coagulation and recovery in pediatric patients with cyanotic congenital hearts disease. Eur J Pediatr. 2014;173:1437-3.
14. Desborough M, Sandu R, Brunskill SJ, Doree C, Trivella M, Montedori A, et al. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015;14:CD007614.
15. Brauer SD, Applegate R, Jameson JJ, Lauer RE, Herrmann PC, Bull BS. Association of plasma dilution with cardiopulmonary bypass-associated bleeding and mortality. J Cardiovasc Thorac Anesth. 2013;27:845-52.
16. Draaissma AM, Hazekamp MG, Frank M, Anes N, Schoof PH, Huysmans HA. Modified ultrafiltration after cardiopulmonary bypass in pediatric cardiac surgery. Ann Thorac Surg. 1997;64:521-5.
17. Steffens TG, Kohmoto T, Edwards N, Wolman RL, Holt DW. Effects of modified ultrafiltration on coagulation as measured by the thromboelastograph. J Extracorp Technol. 2008;40:220-33.
18. Tirosh-Wagner T, Staruss T, Rubinshtein M, Tamarin I, Mishaly D, Paret G. Point of care testing in children undergoing cardiopulmonary bypass. Pediatr Blood Cancer. 2011;56:794-8.
How to Cite
1.
Tamariz-Cruz OJ, Cruz-Sánchez S, Pérez-Pradilla C, Motta-Amézquita LG, Díliz-Nava H, Palacios-Macedo-Quenot A. Identification of a thromboelastographic pattern in children undergoing cardiac surgery with prolonged exposure to cardiopulmonary bypass☆. Colomb. J. Anesthesiol. [Internet]. 2017 Apr. 1 [cited 2024 Apr. 26];45(2):108–113. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/255

Downloads

Download data is not yet available.
Published
2017-04-01
How to Cite
1.
Tamariz-Cruz OJ, Cruz-Sánchez S, Pérez-Pradilla C, Motta-Amézquita LG, Díliz-Nava H, Palacios-Macedo-Quenot A. Identification of a thromboelastographic pattern in children undergoing cardiac surgery with prolonged exposure to cardiopulmonary bypass☆. Colomb. J. Anesthesiol. [Internet]. 2017 Apr. 1 [cited 2024 Apr. 26];45(2):108–113. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/255
Issue
Vol. 45 No. 2 (2017)
Section
Original

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: