P0344 / #1483: EPIDEMIOLOGY OF BLEEDING IN CRITICALLY ILL CHILDREN FOLLOWING CARDIOPULMONARY BYPASS

Abstract

Aims & Objectives: To describe the epidemiology of bleeding in critically-ill children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: We conducted a retrospective cohort study of critically ill l children 1 month to 18 years of age who underwent cardiac surgery with CPB and admitted to New York-Presbyterian Hospital from 2011-2017. Children were excluded if they required ECMO, died within 6 hours of admission or had a known pre-existing bleeding disorder. Severe bleeding was defined by the Bleeding Assessment Scale in Critically Ill Children (BASIC). Intra-operative data, post-operative blood loss, post-operative medical management and outcome data were collected. Results: 137 patients were enrolled. Sixty-four percent (87/137) were male with median (IQR) age of 22 (5-80) months. Majority of surgeries were RACHS2 (51%, 70/137) or RACHS3 (31%, 43/137). Seven percent (10/137) experienced severe bleeding post-operatively. No differences existed between those with severe bleeding and those without with respect to gender (p=.260), RACHS score (p=0.178), age (p=0.336) or weight (p=0.336). Those with severe bleeding received more platelets (p=0.045), plasma (p=0.034) and cryoprecipitate intra-operatively, but not more RBCs (p=0.096). Patients with severe bleeding had significantly longer times on CPB (p=0.018) and cross-clamped (p=0.002). Ninety percent of those with severe bleeding received blood products post-operatively and many received multiple products. Those with severe bleeding had significantly less PICU-free days (p=0.043) but no difference in ventilator-free days (p=0.095). Conclusions: Seven percent of children who undergo cardiac surgery with CPB had a severe bleeding event post-operatively. These children received more blood products intra-operatively and experienced worse clinical outcomes.