Issue |
J Extra Corpor Technol
Volume 26, Number 3, September 1994
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Page(s) | 126 - 128 | |
DOI | https://doi.org/10.1051/ject/1994263126 | |
Published online | 21 August 2023 |
Original Article
Heparin Dose Response in Pediatric Cardiopulmonary Bypass
Children's Hospital, Cardiovascular Perfusion Department, Columbus, Ohio
* Address correspondence to: Vincent F. Olshove Jr., BS, CCT, Children's Hospital, Cardiovascular Perfusion Department, 700 Children's Drive, J260, Columbus, OH 43205
Heparin dosing for cardiopulmonary bypass is frequently based on empirical loading doses. Most cite this heparin loading dose as 3 mg/kg (300 units/kg) for both adults and pediatric patients. The purpose of this study was to retrospectively evaluate the heparin dose response (HDR) in a pediatric population.
The HDR of 268 pediatric patients presenting for repair of congenital heart defects at Children's Hospital, Columbus, Ohio, was gathered retrospectively from May 1992 to October 1993. The HDR was gathered for the entire population and divided into four groups based on patient weight: Group I ≤ 5.0 kg; Group II 5.1 to 10.0 kg; Group III 10.1 to 20.0 kg; Group IV > 20 kg.
The HDR is reported as mean (SD, range) in mg/kg. For the entire population (n = 268) the HDR was 3.5 mg/kg (1.20, 1.0 to 7.3). For patients > 20 kg (group IV, n =58) the HDR was 3.0 mg/kg (0.8, 1.0 to 4.9); Group III (10.1 to 20.0 kg, n = 80) HDR was 3.5 mg/kg (1.1, 2.0 to 7.3). Group II (5.1 to 10.0 kg, n = 66) HDR was 3.8 mg/kg (1.2, 1.8 to 7.3). Group I(≤ 5.0 kg, n = 64) HDR was 3.9 mg/kg (1.3, 1.5 to 7.3). Twenty-seven percent of the total population had a HDR > 4.0 mg/kg. When compared by weight, 10% of the patients > 20.0 kg had a HDR > 4.0 mg/kg compared to 45% of the patients < 5.1 kg.
The heparin dose required by children becomes greater as the patient weight (size) decreases with more patients requiring > 400 units/kg. The use of a fixed dose protocol of heparin in the pediatric patient becomes increasingly inadequate as the patient size decreases. Heparin administration in the pediatric patient should be specific to the individual patient with a heparin dose response calculated for each patient.
Key words: cardiopulmonary bypass / heparin / heparin dose response / pediatric
© 1994 AMSECT
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