Kaolin‐activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study
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Titel:
Kaolin‐activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study
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<jats:title>Summary</jats:title><jats:sec><jats:title>Background and Aims</jats:title><jats:p>Several studies report the use of thromboelatography (<jats:styled-content style="fixed-case">TEG</jats:styled-content>) to monitor coagulation in pediatric cardiac surgery. The aim of this study was to compare baseline and intraoperative <jats:styled-content style="fixed-case">TEG</jats:styled-content>,<jats:styled-content style="fixed-case"> TEG</jats:styled-content>‐functional fibrinogen, and standard coagulation assays in children with cyanotic and acyanotic congenital heart disease (<jats:styled-content style="fixed-case">CHD</jats:styled-content>) undergoing cardiac surgery.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a prospective observational study of 63 children aged <24 months undergoing cardiac surgery with cardiopulmonary bypass (<jats:styled-content style="fixed-case">CPB</jats:styled-content>). Exclusion criteria included preoperative anticoagulant therapy and hepatic failure.</jats:p><jats:p>We collected blood at anesthesia induction (T1), at lowest temperature after <jats:styled-content style="fixed-case">CPB</jats:styled-content> start (T2), and after heparin neutralization (T3). Coagulation was evaluated by <jats:styled-content style="fixed-case">TEG</jats:styled-content> (reaction time [<jats:italic>R</jats:italic>]), <jats:italic>k</jats:italic>, alpha‐angle, maximum amplitude (<jats:styled-content style="fixed-case">MA</jats:styled-content>), <jats:styled-content style="fixed-case">MA</jats:styled-content>‐fibrinogen (<jats:styled-content style="fixed-case">MA</jats:styled-content>‐fib), and by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet [PLT] count).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Sixty‐three patients were enrolled (38 cyanotic and 25 acyanotic). Median age was 4 [<jats:styled-content style="fixed-case">IQR</jats:styled-content> 2–6] months and median weight was 5 [<jats:styled-content style="fixed-case">IQR</jats:styled-content> 3.7–6.5] kg. Most common surgeries were: ventricular septal defect repair (<jats:italic>n</jats:italic> = 13), Fallot correction (<jats:italic>n</jats:italic> = 11), and arterial switch operation (<jats:italic>n</jats:italic> = 10). Cyanotic and acyanotic children were well matched: <jats:italic>R</jats:italic>,<jats:italic> k</jats:italic>,<jats:styled-content style="fixed-case"> MA</jats:styled-content>, and <jats:styled-content style="fixed-case">MA</jats:styled-content>‐fib at T1, T2, and T3 were not significantly different between cyanotic and acyanotic children. At T2, significant correlations were showed between <jats:styled-content style="fixed-case">MA</jats:styled-content> and PLT count (<jats:italic>r</jats:italic> = 0.4; <jats:italic>P</jats:italic> = 0.0008) and <jats:italic>k</jats:italic> and plasma fibrinogen level (<jats:italic>r</jats:italic> = −0.54; <jats:italic>P</jats:italic> < 0.0001). At T3, significant correlations were showed between <jats:styled-content style="fixed-case">MA</jats:styled-content> and PLT count (<jats:italic>r</jats:italic> = 0.5; <jats:italic>P</jats:italic> < 0.0001), G and PLT count (<jats:italic>r</jats:italic> = 0.6; <jats:italic>P</jats:italic> < 0.0001), and <jats:styled-content style="fixed-case">MA</jats:styled-content>‐fib and plasma fibrinogen level (<jats:italic>r</jats:italic> = 0.5; <jats:italic>P</jats:italic> = 0.002).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>According to our findings, cyanosis does not affect <jats:styled-content style="fixed-case">TEG</jats:styled-content> parameters in children with <jats:styled-content style="fixed-case">CHD</jats:styled-content>. PLT count and plasma fibrinogen significantly correlated (are significantly associated) with <jats:styled-content style="fixed-case">MA</jats:styled-content> and <jats:styled-content style="fixed-case">MA</jats:styled-content>‐fib respectively, suggesting that use of <jats:styled-content style="fixed-case">TEG</jats:styled-content> after protamine administration may be prompted for improved hemostatic monitoring in the perioperative phase.</jats:p></jats:sec>