[Homologous fresh frozen plasma in heart surgery. Myth or necessity]

Abstract

Routine administration of homologous fresh frozen plasma (FFP) is widely carried out in cardiac surgery although the risks of blood transfusion can never be excluded. The effect of two units of FFP (430 +/- 11 ml) given after the end of extracorporeal circulation (ECC) (group 1, n = 20) was compared to a control group (n = 20) without FFP in elective aorto coronary bypass patients. Various laboratory parameters, including coagulation data, were measured before and after the end of ECC up to the 1st postoperative day. The patients were comparable with regard to biometric data, anesthesia, and surgical procedure. The major result of this study shows, that routine administration of FFP has no beneficial effect with respect to hemostatic balance. In comparison to a control group, the increase in elastase and decrease in paO2 was even more pronounced in the FFP group. Both blood loss and the need for blood transfusion did not differ between the groups. It can be concluded that a bleeding tendency in cardiac surgery may be caused by ECC itself and by perioperative plasma loss. The routine administration of a relatively small amount of FFP has no positive influence on hemostasis. Substitution therapy in this situation should be guided by the results of coagulation studies.