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 SM ISO690:2012FARAONI, David, WILLEMS, Ariane, SAVAN, Veaceslav, DEMANET, Helene, DE VILLE, Andree, VAN DER LINDEN, Philippe J.F.. Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery: A retrospective review. In: European Journal of Anaesthesiology , 2014, vol. 31, pp. 317-326. ISSN 0265-0215. DOI: https://doi.org/10.1097/EJA.0000000000000043 |
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  European Journal of Anaesthesiology |
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| Volumul 31 / 2014 / ISSN 0265-0215 /ISSNe 1365-2346 | ||||||
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| DOI:https://doi.org/10.1097/EJA.0000000000000043 | ||||||
| Pag. 317-326 | ||||||
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BACKGROUND: Fibrinogen supplementation is increasingly recommended with the use of rotational thromboelastometry (ROTEM). However, data regarding the paediatric population are sparse. OBJECTIVE: We aimed to assess the relationship between plasma fibrinogen concentration and postoperative blood loss in children undergoing cardiac surgery. DESIGN: Retrospective analysis. SETTING: Data prospectively recorded in our departmental database between September 2010 and January 2012. PATIENTS: Data from 156 children scheduled for congenital heart surgery with ROTEM performed at the end of cardiopulmonary bypass (CPB) were analysed. INTERVENTION: None. MAIN OUTCOME MEASURES: Abnormal bleeding was defined as blood loss that exceeded 10% of total blood volume within the first 6 postoperative hours. Logistic regression analyses were used to determine variables associated with bleeding. Correlation analyses and receiver operating characteristic (ROC) curves were designed to evaluate the relationship between blood loss and plasma fibrinogen concentration or ROTEM variables, if relevant. RESULTS: Thirty-six children were considered as 'bleeders' and 120 as 'nonbleeders'. Univariate and multivariate logistic regression analysis revealed time for wound closure, clot formation time, maximal clot firmness (MCF) and plasma fibrinogen concentration as variables independently associated with postoperative bleeding. MCF was best correlated with plasma fibrinogen concentration. ROC curves for blood loss versus fibrinogen concentration and MCF showed that a plasma fibrinogen concentration of 1.5 g l-1 and a MCF value 3mm or less could be used to predict blood loss. CONCLUSION: Post-CPB plasma fibrinogen concentration significantly influences blood loss in children undergoing cardiac surgery. A fibrinogen concentration of at least 1.5 g l-1 or a MCF of at least 3mm should accurately predict excessive blood loss in cardiac surgery children. Further prospective trials are needed to assess the effect of fibrinogen supplementation on postoperative blood loss in this population |
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| Cuvinte-cheie MeSH Blood Coagulation, blood transfusion, Cardiac Surgical Procedures, child, preschool, female, fibrinogen, Humans, infant, Male, Postoperative Hemorrhage, Prospective Studies, Retrospective Studies, Thrombelastography, Treatment Outcome EMTREE drug terms fibrinogen, fresh frozen plasma, protamine, thrombocyte concentrate, fibrinogen EMTREE medical terms article, blood clotting, blood volume, cardiopulmonary bypass, child, congenital heart malformation, controlled study, erythrocyte transfusion, female, fibrinogen blood level, heart surgery, hospitalized child, human, infant, major clinical study, Male, pediatric surgery, Postoperative Hemorrhage, preschool child, receiver operating characteristic, retrospective study, surgical patient, thromboelastograph, wound closure, blood, blood transfusion, heart surgery, metabolism, mortality, Postoperative Hemorrhage, prospective study, statistics and numerical data, thromboelastography, treatment outcome |
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