Fresh Frozen Plasma Versus Solvent Detergent Plasma for Cardiopulmonary Bypass Priming in Neonates and Infants Undergoing Cardiac Surgery: A Retrospective Cohort Study

Abstract

ObjectiveCompared with Fresh Frozen Plasma (FFP), Omniplasma has been attributed to an increased coagulation potential and an increased fibrinolytic potential. This study aimed to compare Omniplasma and FFP used for cardiopulmonary bypass (CPB) priming regarding the incidence of post-operative thrombotic-or haemorrhagic complications and outcome in paediatric patients undergoing cardiac surgery. DesignA retrospective observational cohort study SettingThis single-center study was performed in the University Medical Center Groningen ParticipantAll paediatric patients up to 10 kg undergoing cardiac surgery with CPB. InterventionsProcedures where FFP was used for CPB priming were compared with those where Omniplasma was used. Measurements and main resultsThe primary outcome parameter was a composite endpoint consisting of 1) Paediatric Intensive Care Unit (PICU) mortality, 2) thromboembolic complications, and 3) haemorrhagic complications during PICU stay. We included 143 procedures in the analyses, 90 (63%) in the FFP- and 53 (37%) in the Omniplasma-group. The occurrence of the combined primary endpoint (FFP 20% vs omniplasma 11%, p=0.18 and its components did not differ between the used CPB priming agent). Omniplasma for CPB priming was associated with decreased Unfractionated Heparin administration per kg bodyweight (585 IU vs 510 IU, p=0.03), a higher pre- and post-operative Activated Clotting Time (ACT) discrepancy (90% vs 94%, p=0.03), a lower post-operative ACT value (125 seconds vs 118 seconds, p=0.01), and less Red Blood Cell transfusion per kilogram bodyweight (78 ml vs. 55 ml, p=0.02). However, none of the variables differed statistically significant in the multivariate logistic regression analyses. ConclusionsWe did not find an association between the used plasma for CPB priming and thromboembolic, haemorrhagic complication, and death in neonates and infants undergoing cardiac surgery. Omniplasma seems to be safe to use in this population.