Hemostasis Interest Group: 2019-2020 Activities
By Kelly Machovec, MD
Over the past year, the Hemostasis Interest Group (HIG) initiated a project to examine similarities and differences in how we conduct cardiopulmonary bypass (CPB) cases for neonates. We chose this as a starting point in our discussions on hemostasis and transfusion best practice as the conduct of CPB is a key factor influencing indices of bleeding, coagulopathy, transfusion, and outcomes in children having cardiac surgery.
We conducted a survey of HIG member hospitals examining CPB practices in two neonatal procedures – arterial switch operation and first stage palliation of single ventricle physiology – chosen because these procedures are associated with high rates of coagulopathy and blood transfusion. Seventeen hospitals participated in the survey, and we presented results for the first stage single ventricle palliation group at the CCAS 2020 Annual Meeting. Please click here for our findings. An important lesson from this project is that practice varies not only between institutions but also among anesthesiologists and surgeons at any given institution.
Such variability is understandable given the lack of current evidence to inform best clinical practices. We are now in the process of collaborating for a review that will summarize current research and future directions for neonatal cardiac surgery. Our survey will serve as a springboard to review current evidence for blood product management, anti-fibrinolytic therapy, coagulation monitoring testing, and general elements of CPB management - and then explore needed investigations in each category.
We hope to continue to expand the group and to involve fellows in pediatric anesthesiology and pediatric cardiac anesthesiology in future endeavors with the HIG as we identify new areas of research and collaboration.
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