• David Faraoni, Ariane Willems, Veaceslav Savan, Helene Demanet, Andree De Ville, and Philippe Van der Linden.
• From the Department of Anaesthesiology, Centre Hospitalier Universitaire Brugmann - Queen Fabiola Children's University Hospital, Free University of Brussels (DF, ADV, PVDL), Paediatric Intensive Care Unit, Queen Fabiola Children's University Hospital, Brussels, Belgium (AW), Department of Anaesthesia and Intensive Care, International Hospital Medpark, Chisinau, Republic of Moldova (VS), and Department of Cardiac Surgery, Centre Hospitalier Universitaire Brugmann - Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium (HD).
• Eur J Anaesthesiol. 2014 Jun 1;31(6):317-26.

BackgroundFibrinogen supplementation is increasingly recommended with the use of rotational thromboelastometry (ROTEM). However, data regarding the paediatric population are sparse.ObjectiveWe aimed to assess the relationship between plasma fibrinogen concentration and postoperative blood loss in children undergoing cardiac surgery.DesignRetrospective analysis.SettingData prospectively recorded in our departmental database between September 2010 and January 2012.PatientsData from 156 children scheduled for congenital heart surgery with ROTEM performed at the end of cardiopulmonary bypass (CPB) were analysed.InterventionNone.Main Outcome MeasuresAbnormal bleeding was defined as blood loss that exceeded 10% of total blood volume within the first 6 postoperative hours. Logistic regression analyses were used to determine variables associated with bleeding. Correlation analyses and receiver operating characteristic (ROC) curves were designed to evaluate the relationship between blood loss and plasma fibrinogen concentration or ROTEM variables, if relevant.ResultsThirty-six children were considered as 'bleeders' and 120 as 'nonbleeders'. Univariate and multivariate logistic regression analysis revealed time for wound closure, clot formation time, maximal clot firmness (MCF) and plasma fibrinogen concentration as variables independently associated with postoperative bleeding. MCF was best correlated with plasma fibrinogen concentration. ROC curves for blood loss versus fibrinogen concentration and MCF showed that a plasma fibrinogen concentration of 1.5 g l and a MCF value 3 mm or less could be used to predict blood loss.ConclusionPost-CPB plasma fibrinogen concentration significantly influences blood loss in children undergoing cardiac surgery. A fibrinogen concentration of at least 1.5 g l or a MCF of at least 3 mm should accurately predict excessive blood loss in cardiac surgery children. Further prospective trials are needed to assess the effect of fibrinogen supplementation on postoperative blood loss in this population.

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