Blood ionized calcium concentration following administration of fresh frozen plasma,platelet concentrates and calcium chloride solution during modified ultrafiltration in cardiac surgery for neonates and infants

Abstract

Introduction

During neonatal and infant cardiac surgery, rapid transfusion of fresh frozen plasma (FP) and platelet concentrates (PC), with simultaneous removal of excess water, are performed during modified ultrafiltration (MUF), to raise plasma fibrinogen concentration and platelet counts. Although calcium is administered to treat citrate transfused during this procedure, the appropriate dose of calcium relative to transfusion volume is unknown.

Methods

This retrospective study included neonates (babies under 28 days of age) and infants (babies from 28 days old to less than 1 year old) who underwent MUF during cardiac surgery at our institution in 2 years. Blood ionized calcium concentration ([Ca²⁺]) at the end of cardiopulmonary bypass (CPB) (T₀), end of administration of FP, PC and CaCl₂ during MUF (T₁), and chest closure (T₂) were analyzed. Volumes of FP and PC and dose of CaCl₂ administered between T₀ and T₁ and between T₁ and T₂ were examined.

Results

Eight neonates and 45 infants were included. Regression equations for the total transfusion volume (mL) of FP & PC (y) relative to supplemented dose CaCl₂ (mg) (x) were as follows: y = 1.00*x (r² = 1.00, p < .001) during MUF, and y = 1.05*x (r² = 0.76, p < .001) after MUF. Blood ionized calcium concentrations ([Ca²⁺]) were within the normal range at both T₁ (end of transfusion during MUF) and T₂ (chest closure).

Conclusions

Administering 20 mg CaCl₂ per 20 mL of FP & PC maintains adequate [Ca²⁺] levels at T₁ and T₂ during cardiac surgery in neonates and infants.