Pediatric Resident New York Presbyterian Weill Cornell New York Presbyterian Weill Cornell New York, New York, United States
Background: Pediatric patients undergoing cardiopulmonary bypass (CPB) often require postoperative blood component transfusions. Pathogen-reduced platelets (PRP), treated with amotosalen and ultraviolet A illumination, have recently been developed to reduce the risk of microbial contamination. However, the hemostatic efficacy of this platelet product has not been evaluated in children.
Objective: To characterize the hemostatic efficacy of PRP in children undergoing CPB who receive standard vs PRP.
Design/Methods: We performed a retrospective chart review of patients admitted to a pediatric intensive care unit following CPB surgery from 2015-2019. Demographic data, validated scoring of repair complexity (RACHS score), products and medications received, and outcomes (length of stay, mortality, nosocomial infections, thrombotic complications) were compared. The primary measure of bleeding was chest tube output (cc/kg) at one, two, four, and eight hour intervals postoperatively. With our estimated sample size, a mean difference in chest tube blood loss of 2 cc/kg could be detected with 90% power using a two-sided two-sample equal-variance t-test with a 0.05 significance level.
Results: We enrolled 140 patients. Seventy-two percent of subjects (101/140) were male with a median (IQR) age of 6 (3-35) months. The majority of surgeries (124/140) were RACHS 1-3 repairs. Seventy-four percent of patients (104/140) received only standard platelets whereas twenty-six percent (36/140) received PRP alone. Median platelets received in the operating room were 10.4cc/kg for the pathogen reduced group and 10.2cc/kg for patients who received standard platelets only. There were no differences in the age (p=0.90), sex (p=0.20) or RACHS score (0.06) between the two groups. Postoperatively, those who had received standard platelets received significantly more red blood cells (p=0.007) and more plasma (p=0.003) but there was no difference in receipt of platelets (p=0.18), cellsaver (p=0.79), or cryoprecipitate (p=0.28). There was no difference in chest tube output for 1 hour (p=0.27), 2 hours (p=0.26), 4 hours (p=0.09), 8 hours (p=0.16), or for the first day (p=0.23). Conclusion(s): Patients receiving PRP did not have more blood loss or require more transfusions than those who received standard platelets. This suggests that PRP may provide acceptable hemostasis with the additional benefits of prolonged storage and reduced contamination in pediatric patients undergoing CPB.
Authors/Institutions: Sophia Hsien, New York Presbyterian Weill Cornell, New York, New York, United States; Jeffrey D. Dayton, New York Presbyterian Weill Cornell, New York, New York, United States; Arabela Stock, New York Presbyterian Weill Cornell, New York, New York, United States; Emile A. Bacha, New York Presbyterian Weill Cornell, New York, New York, United States; Melissa Cushing, New York Presbyterian Weill Cornell, New York, New York, United States; Marianne Nellis, New York Presbyterian Weill Cornell, New York, New York, United States