Cardiopulmonary Bypass Parameters and Hemostatic Response to Cardiopulmonary Bypass in Infants Versus Children

Michael J. Eisses, Wayne L. Chandler

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Objective: Because infants have relatively more blood loss (mL/kg) than older children during cardiac surgery involving cardiopulmonary bypass (CPB), the authors compared hemostatic activation between infants and older children undergoing cardiac surgery. Design: Observational study. Setting: University-affiliated children's hospital. Participants: Twenty-eight children (18 infants <1 year and 10 children >1 year) undergoing cardiac surgery with CPB. Interventions: None. Measurements and Main Results: Markers of coagulation and fibrinolysis were evaluated at 9 sample points before, during, and after CPB in the 28 children. Infants had greater chest tube output, longer CPB times, and a larger drop in platelet counts during CPB than children. Active tissue plasminogen activator (tPA) increased during CPB in both groups, with infants showing lower levels than children (p < 0.001). In both groups, active plasminogen activator inhibitor type 1 (PAI-1) first decreased during CPB and then increased above baseline postoperatively. Infants had higher PAI-1 than children near the end of CPB (p = 0.01). Thrombin-antithrombin complex levels increased during and after CPB, with infants showing lower levels only during CPB (p = 0.01). D-dimer and prothrombin activation peptide (F1.2) levels increased in a similar pattern for both groups during and after CPB. The length of aortic cross-clamp time and the level of F1.2 after protamine administration correlated significantly and independently with 12-hour chest tube output. Conclusions: Compared with children, infants had greater blood loss (mL/kg), greater drop in platelets during CPB, lower active tPA, and higher active PAI-1. Cumulative thrombin generation after CPB, indicated by F1.2 levels, correlated with early blood loss.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume22
Issue number1
DOIs
StatePublished - Feb 2008

Keywords

  • cardiopulmonary bypass
  • coagulation
  • congenital heart disease
  • fibrinolysis
  • hemostasis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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