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Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study

Background: Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP thro...

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Autores principales: Ranucci, Marco, Di Dedda, Umberto, Isgrò, Giuseppe, Giamberti, Alessandro, Cotza, Mauro, Cornara, Noemi, Baryshnikova, Ekaterina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299615/
https://www.ncbi.nlm.nih.gov/pubmed/37373602
http://dx.doi.org/10.3390/jcm12123907
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author Ranucci, Marco
Di Dedda, Umberto
Isgrò, Giuseppe
Giamberti, Alessandro
Cotza, Mauro
Cornara, Noemi
Baryshnikova, Ekaterina
author_facet Ranucci, Marco
Di Dedda, Umberto
Isgrò, Giuseppe
Giamberti, Alessandro
Cotza, Mauro
Cornara, Noemi
Baryshnikova, Ekaterina
author_sort Ranucci, Marco
collection PubMed
description Background: Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP throughout the whole perioperative course in this patient population. This retrospective, non-inferiority, propensity-matched study investigates an FFP-free strategy compared to an FFP-based strategy. Methods: Among patients <10 kg with available viscoelastic measurements, 18 patients who received a total FFP-free strategy were compared to 27 patients (1:1.5 propensity matching) receiving an FFP-based strategy. The primary endpoint was chest drain blood loss in the first 24 postoperative hours. The level of non-inferiority was settled at a difference of 5 mL/kg. Results: The 24-h chest drain blood loss difference between groups was −7.7 mL (95% confidence interval −20.8 to 5.3) in favor of the FFP-based group, and the non-inferiority hypothesis was rejected. The main difference in coagulation profile was a lower level of fibrinogen concentration and FIBTEM maximum clot firmness in the FFP-free group immediately after protamine, at the admission in the ICU and for 48 postoperative hours. No differences in transfusion of red blood cells or platelet concentrate were observed; patients in the FFP-free group did not receive FFP but required a larger dose of fibrinogen concentrate and prothrombin complex concentrate. Conclusions: An FFP-free strategy in infants < 10 kg operated with CPB is technically feasible but results in an early post-CPB coagulopathy that was not completely compensated with our bleeding management protocol.
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spelling pubmed-102996152023-06-28 Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study Ranucci, Marco Di Dedda, Umberto Isgrò, Giuseppe Giamberti, Alessandro Cotza, Mauro Cornara, Noemi Baryshnikova, Ekaterina J Clin Med Article Background: Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP throughout the whole perioperative course in this patient population. This retrospective, non-inferiority, propensity-matched study investigates an FFP-free strategy compared to an FFP-based strategy. Methods: Among patients <10 kg with available viscoelastic measurements, 18 patients who received a total FFP-free strategy were compared to 27 patients (1:1.5 propensity matching) receiving an FFP-based strategy. The primary endpoint was chest drain blood loss in the first 24 postoperative hours. The level of non-inferiority was settled at a difference of 5 mL/kg. Results: The 24-h chest drain blood loss difference between groups was −7.7 mL (95% confidence interval −20.8 to 5.3) in favor of the FFP-based group, and the non-inferiority hypothesis was rejected. The main difference in coagulation profile was a lower level of fibrinogen concentration and FIBTEM maximum clot firmness in the FFP-free group immediately after protamine, at the admission in the ICU and for 48 postoperative hours. No differences in transfusion of red blood cells or platelet concentrate were observed; patients in the FFP-free group did not receive FFP but required a larger dose of fibrinogen concentrate and prothrombin complex concentrate. Conclusions: An FFP-free strategy in infants < 10 kg operated with CPB is technically feasible but results in an early post-CPB coagulopathy that was not completely compensated with our bleeding management protocol. MDPI 2023-06-07 /pmc/articles/PMC10299615/ /pubmed/37373602 http://dx.doi.org/10.3390/jcm12123907 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ranucci, Marco
Di Dedda, Umberto
Isgrò, Giuseppe
Giamberti, Alessandro
Cotza, Mauro
Cornara, Noemi
Baryshnikova, Ekaterina
Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title_full Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title_fullStr Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title_full_unstemmed Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title_short Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study
title_sort plasma-free strategy for cardiac surgery with cardiopulmonary bypass in infants < 10 kg: a retrospective, propensity-matched study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299615/
https://www.ncbi.nlm.nih.gov/pubmed/37373602
http://dx.doi.org/10.3390/jcm12123907
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