Audrey Dieu1, Victoria Van Regemorter1, Thierry Detaille2, Laurent Houtekie2, Stéphane Eeckhoudt3, Céline Khalifa1, David Kahn1, Stéphan Clement De Clety2, Alain Poncelet4, Mona Momeni5. 1. Department of Anesthesiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. 2. Department of Pediatric Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. 3. Department of Hematology, Laboratoires des Hôpitaux Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Cardiac Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. 5. Department of Anesthesiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. Electronic address: mona.momeni@uclouvain.be.
Abstract
OBJECTIVES: Few studies have investigated the Multiplate platelet function analyzer in pediatrics. The authors evaluated Multiplate combined with Rotem in terms of guiding platelet transfusion after pediatric cardiac surgery with cardiopulmonary bypass (CPB). The authors further compared coagulation parameters between cyanotic and acyanotic patients. DESIGN: Subgroup analysis of a randomized clinical trial. SETTING: Tertiary hospital. PARTICIPANTS: Patients weighing between seven and 15 kg. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Rotem and Multiplate tests were performed (1) after anesthesia induction, (2) upon CPB separation, and (3) upon intensive care unit arrival. Among a total of 59 subjects, 9 patients required platelet transfusion. In multivariate linear regression, analysis EXTEM maximum clot firmness upon CPB separation was associated with the volume of transfused platelets (regression coefficient = -0.348 [95% confidence interval -1.006 to -0.028]; p = 0.039). No such association was found for the Multiplate test. Acyanotic and cyanotic heart disease were present in 32 and 27 children, respectively. There were no significant differences between these two groups in terms of platelet count and function. Postoperative blood loss was significantly higher in the cyanotic group compared with the acyanotic arm (p = 0.015; difference [95% confidence interval -2.40 {-4.20 to -0.60}]). There were no differences between groups regarding transfusion of allogeneic blood products. CONCLUSIONS: This study showed that Rotem, but not Multiplate results, were associated with platelet transfusion in pediatric cardiac surgery with no intake of platelet inhibitors. The usefulness of combining these tests in platelet transfusion decision-making needs to be evaluated in larger populations.
RCT Entities:
OBJECTIVES: Few studies have investigated the Multiplate platelet function analyzer in pediatrics. The authors evaluated Multiplate combined with Rotem in terms of guiding platelet transfusion after pediatric cardiac surgery with cardiopulmonary bypass (CPB). The authors further compared coagulation parameters between cyanotic and acyanotic patients. DESIGN: Subgroup analysis of a randomized clinical trial. SETTING: Tertiary hospital. PARTICIPANTS: Patients weighing between seven and 15 kg. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Rotem and Multiplate tests were performed (1) after anesthesia induction, (2) upon CPB separation, and (3) upon intensive care unit arrival. Among a total of 59 subjects, 9 patients required platelet transfusion. In multivariate linear regression, analysis EXTEM maximum clot firmness upon CPB separation was associated with the volume of transfused platelets (regression coefficient = -0.348 [95% confidence interval -1.006 to -0.028]; p = 0.039). No such association was found for the Multiplate test. Acyanotic and cyanotic heart disease were present in 32 and 27 children, respectively. There were no significant differences between these two groups in terms of platelet count and function. Postoperative blood loss was significantly higher in the cyanotic group compared with the acyanotic arm (p = 0.015; difference [95% confidence interval -2.40 {-4.20 to -0.60}]). There were no differences between groups regarding transfusion of allogeneic blood products. CONCLUSIONS: This study showed that Rotem, but not Multiplate results, were associated with platelet transfusion in pediatric cardiac surgery with no intake of platelet inhibitors. The usefulness of combining these tests in platelet transfusion decision-making needs to be evaluated in larger populations.
Authors: Meghan Delaney; Oliver Karam; Lani Lieberman; Katherine Steffen; Jennifer A Muszynski; Ruchika Goel; Scot T Bateman; Robert I Parker; Marianne E Nellis; Kenneth E Remy Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Sheila J Hanson; Oliver Karam; Rebecca Birch; Ruchika Goel; Ravi M Patel; Martha Sola-Visner; Bruce S Sachais; Ronald G Hauser; Naomi L C Luban; Jerome Gottschall; Cassandra D Josephson; Jeanne E Hendrickson; Matthew S Karafin; Marianne E Nellis Journal: Pediatr Crit Care Med Date: 2021-11-01 Impact factor: 3.624