Pediatric Resident New York Presbyterian- Weill Cornell New York Presbyterian Weill Cornell Medical Center New York , New York, United States
Background: Children undergoing cardiac surgery involving cardiopulmonary bypass are at high risk of bleeding due to hemodilution, platelet dysfunction and inflammation, among other factors. Bleeding is associated with increased mortality. However, the epidemiology of bleeding in this vulnerable patient population is poorly understood.
Objective: To describe the epidemiology of severe bleeding in the immediate post-operative period in children who have undergone cardiopulmonary bypass (CPB) surgery.
Design/Methods: We conducted a retrospective single center cohort study. We included patients admitted to the pediatric intensive care unit at New York Presbyterian-Weill Cornell from 2015-2018 age 1 month to 18 years undergoing any cardiac surgery with cardiopulmonary bypass. Severe bleeding was defined by the Bleeding Assessment Scale in Critically Ill Children (BASIC).
Results: Two-hundred twenty-five children were enrolled; 59% were male with a median (IQR) age of 2.4 (0.4-8.1) years. Forty patients (18%) had severe bleeding in the first 24 hours post-operatively. Severe bleeding was observed more frequently in younger (p=0.012) and smaller (p=0.003) children with longer bypass (p=0.001) and cross-clamp (p=0.003) times. Gender (p=0.06), surgical complexity (p=0.27), subsequent stages of palliative repairs (p=0.27), and the use of intraoperative aminocaproic acid (p=0.39) or tranexamic acid (p=0.19) were not significantly associated with severe bleeding. There were no significant differences in the median platelet counts (p=0.86), prothrombin time (p=0.49), or fibrinogen level (p=0.84) between those with severe bleeding and those without. Median (IQR) activated partial thromboplastin time (aPTT) was significantly higher in those with severe bleeding as compared to those without (37.5 (33.2-40.3) versus 33.0 (29.5-39.3), p=0.003). Those with severe bleeding had significantly less PICU free days (p=0.005) but no difference in mechanical ventilation free days (p=0.08) as compared to those without severe bleeding. Conclusion(s): Younger age, lower weight, and longer CPB and cross clamp times are associated with a higher risk of severe bleeding after cardiopulmonary bypass surgery in the pediatric population. aPTT may potentially be used to predict bleeding in this vulnerable population.
Authors/Institutions: Lisa Bartucca, New York Presbyterian Weill Cornell Medical Center, New York , New York, United States; Ramzi Shaykh, Weill Cornell, New York , New York, United States; Arabela Stock, NYP-Weill Cornell Hospital, New York, New York, United States; Jeffrey D. Dayton, Weill Cornell Medicine, New York, New York, United States; Emile A. Bacha, NYP-Weill Cornell Hospital, New York, New York, United States; Marianne Nellis, Weill Cornell Medical College, New York, New York, United States
