Format

Send to

Choose Destination
Perfusion. 2009 May;24(3):191-7. doi: 10.1177/0267659109346667. Epub 2009 Sep 18.

Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS.

Author information

1
Departments of Pediatric (Cardiology), University of Michigan Health Systems, Ann Arbor, MI, USA.

Abstract

BACKGROUND/OBJECTIVE:

There is limited literature documenting bleeding patterns in pediatric post-cardiotomy patients on extracorporeal life support (ECLS). This retrospective review details bleeding complications and identifies risk factors for bleeding in these patients.

METHODS:

Records from 145 patients were reviewed. Patients were divided into excessive (E) and non-excessive (NE) bleeding groups based on blood loss.

RESULTS:

Excessive bleeding occurred predominantly from 0-6h. Longer CPB duration (NE=174+/-8 min; E=212+/-16; p=0.02) and lower platelet counts (NE=104.8+/-50K; E=84.3+/-41K; p=0.01) were associated with excessive bleeding during the first 6h (p=0.005). Use of intraoperative protamine with normal platelets was associated with decreased bleeding from 7-12 h post-ECLS (p=0.002). Most mediastinal exploration occurred > 49 h post-ECLS, with decreased bleeding post-exploration in E patients.

CONCLUSIONS:

The majority of pediatric post-cardiotomy ECLS bleeding occurs early after support initiation. Longer CPB time and thrombocytopenia increased bleeding 0-6h post-ECLS. Since early bleeding may be coagulopathic in origin, an approach to minimize bleeding includes protamine administration and aggressive blood product replacement with target platelet counts of 100-120K. Surgical exploration should follow if additional hemostasis is necessary.

PMID:
19767331
DOI:
10.1177/0267659109346667
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center