Coagulation and neonatal bypass: an assessment of changes in coagulation factor concentration during cardiopulmonary bypass in neonates, with modified ultrafiltration

P Arnold,D Bolton,S Haynes,S Jackson,J Smith

doi:10.1186/cc656

Abstract

Bleeding is of major concern in neonates after cardiopulmonary bypass. More severe coagulopathy can be expected in children who weigh under 8 kg. The effect of cardiopulmonary bypass on factor concentration has been described previously using a prime of fresh whole blood. Fresh whole blood is not generally available in the UK. In addition we describe the effect of modified haemofiltration and changes in factor V concentration, which has not previously been described.

Highlights

Jugular bulb oxyhaemoglobin desaturation (SjO2 ≤ 50%) during the rewarming phase of cardiopulmonary bypass (CPB) is associated with postoperative cognitive deficits [1]
The incidence of desaturation during rewarming was significantly reduced by isoflurane. This suggests the balance between cerebral blood flow and Acknowledgement: Funded by Wellcome Trust grant 050190
Leucocyte depleting filters may be capable of selectively removing activated white cells [3], but this has not been proved in vivo

Summary

Introduction

Jugular bulb oxyhaemoglobin desaturation (SjO2 ≤ 50%) during the rewarming phase of cardiopulmonary bypass (CPB) is associated with postoperative cognitive deficits [1]. Cardiopulmonary bypass (CPB) has been shown to induce a systemic inflammatory response similar to the local reaction seen after tissue damage [1] This leads to the release of toxic substances, such as elastase, which cause endothelial damage and may adversely affect outcome [2]. Identification of factors responsible for the development of reduced sensitivity to heparin have important implications for cardiac surgery with cardiopulmonary bypass, because inadequate anticoagulation during this procedure can have profound thrombotic and haemorrhagic consequences. It was noted [1,2] that preoperative platelet levels are higher in heparin-resistant patients than in those who are heparin sensitive. In the present study we investigated the efficacy of clomethiazole in improving neuropsychological outcome after coronary artery bypass surgery

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