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

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

Gail M Annich

Department of Pediatrics (Critical Care Medicine), University of Michigan Health Systems, Ann Arbor, MI, USA

Jennifer C Hirsch

Department of Cardiothoracic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA

Cathe Fahrner

Department of Pediatrics (Critical Care Medicine), University of Michigan Health Systems, Ann Arbor, MI, USA

Pat Brownlee

Department of Pediatrics (Critical Care Medicine), University of Michigan Health Systems, Ann Arbor, MI, USA

Karen King

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

Geoffrey M Fleming

Department of Pediatrics, Division of Critical Care, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, TN, USA

Robert J Gajarski

Departments of Pediatric (Cardiology), University of Michigan Health Systems, Ann Arbor, MI, USA, rjgaj{at}med.umich.edu

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±8min; 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 7-12h post-ECLS (p=0.002). Most mediastinal exploration occurred >49h 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.

Key Words: pediatric ECLS • post-cardiotomy • ECLS bleeding • congenital heart disease • bleeding risk factors

This version was published on May 1, 2009

Perfusion, Vol. 24, No. 3, 191-197 (2009)
DOI: 10.1177/0267659109346667


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