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Management of Cardiopulmonary Bypass-Associated Coagulopathy

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Pediatric Critical Care

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Abstract

Coagulopathy in pediatric patients after cardiopulmonary bypass (CPB) is highly complex and multifactorial. Pediatric patients are at risk for post-CPB coagulopathy due to hemodilution resulting from the CPB circuit, use of varying degrees of hypothermia during surgical procedures, prolonged duration of highly complex surgical repairs, and abnormalities of the immature and cyanotic hematologic system. Hemostasis can be optimized at various stages from the preoperative to postoperative phases. Strategies include intraoperative antifibrinolytic therapy, CPB circuit properties and management, and post-CPB procoagulant therapy. Point-of-care whole-blood assays can be used to more directly guide correction of coagulopathy, utilizing both allogeneic blood products and biosynthetic coagulation factors such as fibrinogen concentrate and prothrombin protein concentrates. This chapter will focus on current controversies surrounding CPB-associated coagulopathy and its management.

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Authors and Affiliations

  1. Riley Hospital for Children, Indianapolis, IN, USA

    Rania K. Abbasi, Anne E. Cossu & Scott G. Walker

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  1. Rania K. Abbasi
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  2. Anne E. Cossu
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  3. Scott G. Walker
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Correspondence to Scott G. Walker .

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  1. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  2. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Kevin M. Valentine

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Abbasi, R.K., Cossu, A.E., Walker, S.G. (2019). Management of Cardiopulmonary Bypass-Associated Coagulopathy. In: Mastropietro, C., Valentine, K. (eds) Pediatric Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96499-7_12

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