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Ann Thorac Surg 2004;77:983-987
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Fresh frozen plasma in the pediatric pump prime: a prospective, randomized trial

Mary M. McCall, MSNa, Mindy M. Blackwell, MSa, Jonathan T. Smyre, MSa, Joseph J. Sistino, MPAa, Jeffrey R. Acsell, BSa, B. Hugh Dorman, MD, PhDb, Scott M. Bradley, MDc*

a Cardiovascular Perfusion Program, Department of Anesthesia, Charleston, South Carolina, USA
b Division of Cardiothoracic Surgery, Charleston, South Carolina, USA
c Medical University of South Carolina, Charleston, South Carolina, USA

* Address reprint requests to Dr Bradley, Division of Cardiothoracic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, USA 29425
e-mail: bradlesm{at}musc.edu

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.

BACKGROUND: The aim of this study was to determine whether the use of fresh frozen plasma (FFP) in the infant pump prime can avoid dilution of fibrinogen, decrease the need for blood product transfusion after bypass, and decrease exposure to donor blood products.

METHODS: Twenty infants weighing less than 8 kg were prospectively randomized to receive either 1 U of FFP (10 patients) or no FFP (10 patients) in the pump prime. Mean age (4.2 ± 2.8 months), weight (4.3 ± 1.1 kg), total prime volume (641 ± 96 ml), cardiopulmonary bypass time, cross-clamp time, lowest temperature on bypass, and preoperative coagulation parameters did not differ between the two groups.

RESULTS: At the end of bypass, the mean fibrinogen level was significantly higher in the FFP than the no FFP group (123 ± 20 versus 58 ± 17 mg/dL; p < 0.0001), whereas the mean platelet count did not differ (60 ± 25 versus 52 ± 26 K/mm3; p = 0.5). Patients in the FFP group received significantly fewer units of cryoprecipitate (0.4 ± 0.8 versus 2.0 ± 0.9 U/patient; p < 0.001), and had a mean total donor exposure of 4.1 ± 1.5 U/patient versus 5.4 ± 1.4 U/patient in the no FFP group (p = 0.06). The mean chest tube output over the first 24 hours did not differ between groups.

CONCLUSIONS: The use of FFP in the pump prime significantly limited dilutional hypofibrinogenemia, decreased the transfusion of cryoprecipitate after bypass, and tended to decrease the overall mean patient exposure to blood products.






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