Document Detail

Heparin therapy during cardiopulmonary bypass in children requires ongoing quality control.
MedLine Citation:
PMID:  8165615     Owner:  NLM     Status:  MEDLINE    
Heparin therapy for children undergoing cardiopulmonary bypass (CPB) is monitored in the operating room by automated whole blood activated clotting times (ACT). For many years our institution used Hemochron (HC) ACT machines but changed to HemoTec (HT) ACT machines because they required a smaller blood sample and provided results in duplicate. When HemoTec ACT machines were introduced at our institution, the surgical team was concerned that increased amounts of heparin were being administered to our patients during CPB. This study was conducted to investigate the potential mechanisms responsible for these clinical observations. First, we compared ACT values on ex vivo blood samples from 20 consecutive pediatric patients (6 samples each) during CPB. The HC ACT values were significantly and systematically increased over HT ACT values (HC: 750 +/- 40 vs HT: 418 +/- 26, Mean +/- SEM, p < 0.01). 94% of all HC ACT values were above 450 s compared to only 27% of HT ACT values. If HT ACT values had been used for patient monitoring, all patients would have received more heparin to achieve ACT values above 450 s. The two machines reported similar ACT values when heparin was added in vitro to whole blood (0.1-5.0 units/ml), (HC: Y = 98X + 104, r2 = 0.93 HT: Y = 82X + 109, r2 = 0.94). Heparin concentrations in our patients following a bolus of 300 U/kg of heparin, but prior to CPB were 3.2 +/- 0.07 units/ml. Following the initiation of CPB, heparin concentrations decreased to 1.3 +/- 0.05, reflecting, in part hemodilution by the pump prime (1 U of heparin/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
M Andrew; B MacIntyre; J MacMillan; W G Williams; C Gruenwald; M Johnston; F Burrows; E Wang; M Adams
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  70     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  1993 Dec 
Date Detail:
Created Date:  1994-05-23     Completed Date:  1994-05-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  937-41     Citation Subset:  IM    
Department of Pediatrics and Pathology, McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Cardiopulmonary Bypass*
Child, Preschool
Heparin / therapeutic use*
Monitoring, Physiologic / instrumentation,  standards
Quality Control
Whole Blood Coagulation Time*
Reg. No./Substance:

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