Congenital Heart Disease
Conditions
Keywords
Congenital Heart Disease, Point-of-care coagulation monitoring
Brief summary
Neonates, children with single ventricle congenital heart disease, and those undergoing multiple complex cardiac surgeries are at high risk of increased perioperative blood loss, and blood product transfusions. In addition, some of these patients will present an increased risk of postoperative thromboembolic complications. For a long time, bleeding management has been based on the empiric administration of different blood products (e.g. platelet concentrates, cryoprecipitates, and/or activated factor VII), topical hemostatic agents, and surgical manipulation. Recently, the use of viscoelastic tests (e.g. thromboelastography (TEG) or thromboelastometry (ROTEM)) increased, and allowed a better assessment of perioperative coagulopathy, and a more 'rational' treatment of bleeding. While TEG and ROTEM record the viscoelastic properties of whole blood by measuring mechanical impedance and related changes during clot formation, T2MR, a miniaturized, magnetic resonance-based diagnostic platform, measures how water molecules react in the presence of magnetic fields to evaluate a broad range of hemostasis measurements. In this study, we will prospectively collect demographic data, surgical characteristics, the amount of perioperative bleeding and blood product transfusion, results of laboratory assays, and postoperative outcomes (30-day follow-up or until discharge), with the aim to assess our current practice, and develop an algorithm-based approach for the administration of targeted blood product and pro-coagulant therapies. Our goals are: the reduction of blood product utilization, the reduction of the incidence of massive bleeding and postoperative thrombosis.
Interventions
Will utilize the discarded blood from routine clinical blood samples to evaluate the input of the newer technologies that helped for the diagnostic of coagulopathy.
Will utilized the discarded urine samples from the routinely placed Foley catheter to measure the indices of oxidative stress.
Sponsors
Boston Children's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Neonates and infant patients (0 -12 months of age) undergoing complex cardiac surgical procedures * cardiac surgery patient \> 12 months of age who has previously undergone 2 or more sternotomies
Exclusion criteria
* child in a moribund condition (American Society of Anesthesiology (ASA 5) * children with a hematological and/or oncological disease * Jehovah witnesses * If the child is only undergoing a patent ductus arteriosus (PDA) ligation or other procedures not considered at risk for thrombosis and/or bleeding or they do not provide consent for enrollment (e.g. Ventricular Septal Defect repair)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Evaluate newer technologies for coagulation diagnostics with the aim to standardize bleeding management in high risk cardiac patients | 1 year |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJuan Ibla, MD
Boston Children's Hospital
Outcome results
None listed