Sonoclot® predicts operation time and blood loss after cardiopulmonary bypass in children

Abstract

BackgroundAs the circulating blood volume is relatively small in pediatric patients, blood components are quickly lost when bleeding, which make it more difficult to stop the bleeding. Particularly in pediatric cardiac surgery, loss of clotting factors associated with cardiopulmonary bypass (CPB) would likely to be prominent. As a result, bleeding is further promoted and the operation time is extended. In order to search for the relation between clotting factors and the amount of bleeding, we used a viscoelastic point of care test. ObjectivesWe used Sonoclot® as viscoelastic point of care test to evaluate coagulation function before CPB and before weaning from CPB in pediatric cardiac surgery. DesignRetrospective. SettingSingle-institutional. ParticipantsWe included 55 pediatric patients (median age 13 months [IQR 5–32]) who underwent cardiac surgery under CPB from December 2015 to November 2016. InterventionsNone. Measurements and main resultsSonoclot® analysis was performed after induction of anesthesia (pre-data, or baseline data) and before any heparinized saline was given, and right after modified ultrafiltration after weaning from CPB (post-data). Post-data was compared with post-CPB operation time and post-CPB blood loss by multiple regression analysis. Furthermore, effects of fresh frozen plasma (FFP) added on CPB on coagulation function and post-platelet function (describe as PFSC) was assessed. Activated coagulation time (describe as ACTSC) and clot rate (describe as CRSC) showed no significant change between baseline data and post-data. Post-PFSC was worsened by prolonged CPB time (p < 0.05) and correlated to bleeding amount and operation time after CPB (p < 0.05). Total amount of platelet concentrate (PC) transfused was higher in patients with smaller PFSC (p < 0.05). Total amount of FFP and PC transfused correlated with bleeding amount and operation time after CPB (p < 0.05). In the subgroup analysis, PFSC declined in the FFP-included group, whereas there was no significant difference in coagulation function. Addition of FFP to CPB did not significantly affect CR, whereas PFSC deteriorated as CPB time was prolonged (CPB time = 1/(0.0021∗PFSC + 0.0055)). ConclusionSonoclot® is useful to evaluate coagulation function in pediatric patients who undergo CPB. Preventive administration of FFP or PC in CPB circuit could reduce bleeding after CPB.