Clinical comparison of patient-side fibrinogen assay and common laboratory analyzer in pediatric cardiopulmonary bypass

The coagulation status of infant and pediatric patients can be severely compromised during the course of cardiopulmonary bypass due primarily to hemodilution and hypothermia. Fibrinogen level is one source of information necessary to assess the coagulation status of a patient. An accurate and expedient method to determine the fibrinogen level would allow for earlier initiation of coagulation therapy to prevent excessive postoperative bleeding. The purpose of this study was to compare two methods of determining fibrinogen level: a patient-side assay and a common laboratory analyzer. The patient-side test utilized the HemoChron Fibrinogen Assay and was performed in the operating room. The MLA 1000C was the laboratory method utilized in the hospital's coagulation laboratory. Simultaneous testing was conducted prebypass and intraoperatively on 26 infant and pediatric patients undergoing cardiopulmonary bypass for palliation and correction of congenital heart defects. The resulting values were compared using paired t-test, regression and correlation analysis, and descriptive analysis. The values obtained by the two methods were significantly different (p < .05) at each collection time. Further analysis revealed that other variables, such as hematocrit and platelet count, affected the differences between the results of the methods. The HemoChron Fibrinogen Assay may not be a viable tool for the assessment of fibrinogen level on infant and pediatric patients undergoing cardiopulmonary bypass surgery. Further studies should be done in this patient population incorporating other confounding variables.