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Hemostatic Response in Paediatric Patients Undergoing Cardiopulmonary Bypass Surgery

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Abstract

This prospective, single-center cohort study aimed to evaluate the hemostatic response during and after Cardiopulmonary Bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at eight time points: post-induction of anesthesia, pre-unfractionated heparin (UFH), post-UFH, post-initiation of bypass, pre-protamine, post-protamine, post-chest-closure, and 6 h post-chest-closure. As expected, all measures of the UFH effect increased significantly post-UFH bolus and decreased post-protamine administration. However, thrombin generation remained inhibited compared to baseline values despite the post-UFH reversal by protamine. We also demonstrate that residual UFH effect is not responsible for the ongoing inhibition of thrombin observed post-protamine administration. The significant increase in both free and total tissue factor pathway inhibitor levels during the CPB surgery might contribute to the persistent thrombin generation/endogenous thrombin potential inhibition post-protamine administration. This study makes a significant and novel contribution by investigating the physiological mechanisms behind the degree of thrombin inhibition by UFH and the residual levels of thrombin inhibition that continue despite protamine reversal and provides a new foundation for future interventional studies in the setting of paediatric CPB surgery.

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Acknowledgments

The authors acknowledge the assistance of the cardio-thoracic surgical unit and, in particular, Dr. Martin Bennett. The authors are also very grateful for the assistance of the PICU nursing staff in collecting the S8 samples. The Haematology Research Group provided internal funding.

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Authors and Affiliations

  1. Haematology Research Laboratory, Murdoch Children’s Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia

    Vera Ignjatovic, Robyn Summerhayes, Fiona Newall & Paul Monagle

  2. Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Vera Ignjatovic, Robyn Summerhayes, Fiona Newall, Andrew Cochrane & Paul Monagle

  3. Departments of Nursing, The University of Melbourne, Melbourne, Australia

    Fiona Newall

  4. Department of Clinical Haematology, Royal Children’s Hospital, Melbourne, Australia

    Jenny Than, Fiona Newall & Paul Monagle

  5. Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Australia

    Stephen Horton

  6. Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia

    Andrew Cochrane

Authors
  1. Vera Ignjatovic
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  2. Jenny Than
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  3. Robyn Summerhayes
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  4. Fiona Newall
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  5. Stephen Horton
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  6. Andrew Cochrane
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  7. Paul Monagle
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Correspondence to Vera Ignjatovic.

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Ignjatovic, V., Than, J., Summerhayes, R. et al. Hemostatic Response in Paediatric Patients Undergoing Cardiopulmonary Bypass Surgery. Pediatr Cardiol 32, 621–627 (2011). https://doi.org/10.1007/s00246-011-9929-4

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  • DOI: https://doi.org/10.1007/s00246-011-9929-4

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