I would like to find evidences regarding the use of fresh frozen plasma as a prime solution in neonates undergoing cardiac surgery with cardiopulmonary bypass.
In my department, we systematically use FFP if < 1 month of age.
1. Do you have any other experiences?
2. Do you have some relevant references ?
Dear Mr Faraoni
unfortunately, we have no expertise on pediatric samples
Best regards
We almost never use FFP in any pediatric cardiac surgery. Same for platelets. Our surgeons do not believe in prophylactic use of these products.
I should add that our mortality rates are fairly low considering the high complexity of the surgery.
Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: results of a prospective, randomized, controlled clinical trial.
Cholette JM, Henrichs KF, Alfieris GM, Powers KS, Phipps R, Spinelli SL, Swartz M, Gensini F, Daugherty LE, Nazarian E, Rubenstein JS, Sweeney D, Eaton M, Lerner NB, Blumberg N.
Pediatr Crit Care Med. 2012 May;13(3):290-9. doi: 10.1097/PCC.0b013e31822f173c.
Thank you for your answer. I agree with you, the multidisciplinary approach with good surgeon is really important if you need to decrease blood products transfusion.
I know your paper, congrats. It would be great to collect large amount of data and compared practices between centers (mortality, morbidity, transfusion rate, ...)
We use Fresh Whole Blood as a routine to decrease donor exposures and optimize hemostasis, when unavalible we mix PRBc's with FFP and then add to the perfusate.
Hello Mr. Faraoni,
I can remember no instances where the "age" of an FFP unit was considered for any transfusion. Our blood supplier routinely provided pediatric three-pack splits (~80cc) of type AB plasma that we used for infant transfusions.We do have an active NICU and pediatric intensive care unit so we did go through these units very quickly. I have not heard of any changes to this policy.
I'll forward your question about the plasma prime to my colleagues.
We do not use FFP in our neonatal prime, we use albumin (there are papers showing this is a better option than FFP in the prime). We add the FFP as a replacement fluid during zero balance ultrafiltration. This minimises the prime volume and allows a full unit of FFP (250-300 ml) to be utilised even on a small neonate. The patients leave theatre with normal fibrinogen levels.
Hi, Unfortunately I have no exprience on pediatric surgery.
we use FFP in the pump prime , in neonates undergoing the first stage of surgical correction of HLHS.and requiring aortic arch repair
under deep hypothermic circulatory arrest.
David
It is the practice here at Stanford Children's Hospital to add FFP on pump. It may not be added right at the begining but as we ultrafilter (ZBUF) during CPB the crysalloid volume is replaced with FFP. So a neonate will have 3/4 to 1 unit of FFP dur ing CPB. Post CPB we do not use FFP>.
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