Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery: A Randomized Clinical Trial
Audrey Dieu, M.D.; Maria Rosal Martins, M.D.; Stephane Eeckhoudt, Ph.D.; Amine Matta, M.D.; David Kahn, M.D.; et alCéline Khalifa, M.D.; Jean Rubay, M.D., Ph.D.; Alain Poncelet, M.D., Ph.D.; Astrid Haenecour, M.D.; Emilien Derycke, M.D.; Dominique Thiry, C.C.P.; André Gregoire, C.C.P.; Mona Momeni, M.D., Ph.D.
 Author Notes
From the Departments of Anesthesiology (A.D., M.R.M., A.M., D.K., C.K., M.M.), Hematology (S.E.), Cardiac Surgery (J.R., A.P.), and Perfusion Services (D.T., A.G.) and the Pediatric Intensive Care Unit (A.H., E.D.), University Hospital Saint Luc, Catholic University of Louvain (Cliniques Universitaires Saint Luc, Université Catholique de Louvain), Brussels, Belgium.
This work has been presented at the Euroanaesthesia Meeting 2018 in Copenhagen, Denmark, June 2 to 4, 2018.
A.D. and M.R.M. contributed equally to this article.
Submitted for publication February 7, 2019. Accepted for publication September 9, 2019.
Correspondence: Address correspondence to Prof. Momeni: Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. mona.momeni@uclouvain.be. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Anesthesiology Newly Published on October 23, 2019. doi:10.1097/ALN.0000000000003017

Fresh frozen plasma is often used to prime the cardiopulmonary bypass circuit for pediatric cardiac surgical patients to help offset dilutional coagulopathy that might result in increased perioperative bleeding and allogeneic blood transfusion

Prior randomized trials of crystalloid versus fresh frozen plasma prime have reported conflicting results, but the vast majority of these studies were not blinded

What This Article Tells Us That Is New:

In this double-blind randomized controlled trial of patients undergoing pediatric cardiac surgery with cardiopulomonary bypass, postoperative bleeding and the need for allogeneic blood products does not differ significantly between patients for whom the cardiopulmonary bypass circuit was primed with crystalloid versus fresh frozen plasma

Background: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion.

Methods: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival.

Results: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg−1 (5.1, 9.4) in the FFP group and 5.7 ml · kg−1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events.

Conclusions: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.