School of Medicine and Health Sciences Poster Presentations

Title

Intraoperative Administration of ε-Aminocaproic Acid (EACA) Reduces Blood Loss in Pediatric Craniofacial Reconstructive Surgery

Poster Number

197

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Surgical correction of craniosynostosis in pediatric patients is a complex procedure that results in significant blood loss and transfusion requirements. Antifibrinolytic agents have been shown to reduce blood loss in pediatric patients undergoing other types of major surgery involving significant blood loss. Two recent retrospective studies suggest the benefit of ε-aminocaproic acid (EACA) in reducing blood loss in pediatric craniofacial surgery.1,2 Pharmacokinetic data in children undergoing craniofacial surgery recommends administering 100 mg/kg EACA loading dose followed by a continuous infusion at 40 mg/kg/hr in order to maintain target plasma EACA concentrations.3 This study aims to provide further evidence supporting the use of EACA in pediatric craniofacial surgery using this specific dosing regimen.

Methods: This is a retrospective study of children (4 months to 8 years of age) with craniosynostosis who underwent bifrontal orbital advancement or calvarial vault reconstruction surgery at out institution between July 2013 and December 2015. We compared intraoperative calculated blood loss, RBC transfusion volume, blood donor exposures, and postoperative surgical drain output between patients who received EACA and those who did not receive EACA.

Results: A total of 44 patients were included in the study; 18 received EACA and 26 did not receive EACA. Both the EACA and non-EACA groups were analyzed for confounding characteristics and surgical variables and no significant differences between the two groups were found. The EACA group had a significantly lower calculated blood loss (37 ± 18 vs. 63 ± 45 mL/kg, P = 0.004) reduced RBC transfusion requirements (14 ± 12 vs. 30 ± 24 mL/kg, P < 0.001), and fewer intraoperative blood donor exposures (median 1, interquartile range 0-1 vs. median 1, interquartile range 1-1; P = 0.002) than the non-EACA group. There was no significant difference in the first postoperative 24-hour surgical drain output between the two groups.

Conclusion: EACA, administered at the recommended dosing regimen, is associated with decreased calculated blood loss, RBC transfusion requirements, and intraoperative blood donor exposures.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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Intraoperative Administration of ε-Aminocaproic Acid (EACA) Reduces Blood Loss in Pediatric Craniofacial Reconstructive Surgery

Background: Surgical correction of craniosynostosis in pediatric patients is a complex procedure that results in significant blood loss and transfusion requirements. Antifibrinolytic agents have been shown to reduce blood loss in pediatric patients undergoing other types of major surgery involving significant blood loss. Two recent retrospective studies suggest the benefit of ε-aminocaproic acid (EACA) in reducing blood loss in pediatric craniofacial surgery.1,2 Pharmacokinetic data in children undergoing craniofacial surgery recommends administering 100 mg/kg EACA loading dose followed by a continuous infusion at 40 mg/kg/hr in order to maintain target plasma EACA concentrations.3 This study aims to provide further evidence supporting the use of EACA in pediatric craniofacial surgery using this specific dosing regimen.

Methods: This is a retrospective study of children (4 months to 8 years of age) with craniosynostosis who underwent bifrontal orbital advancement or calvarial vault reconstruction surgery at out institution between July 2013 and December 2015. We compared intraoperative calculated blood loss, RBC transfusion volume, blood donor exposures, and postoperative surgical drain output between patients who received EACA and those who did not receive EACA.

Results: A total of 44 patients were included in the study; 18 received EACA and 26 did not receive EACA. Both the EACA and non-EACA groups were analyzed for confounding characteristics and surgical variables and no significant differences between the two groups were found. The EACA group had a significantly lower calculated blood loss (37 ± 18 vs. 63 ± 45 mL/kg, P = 0.004) reduced RBC transfusion requirements (14 ± 12 vs. 30 ± 24 mL/kg, P < 0.001), and fewer intraoperative blood donor exposures (median 1, interquartile range 0-1 vs. median 1, interquartile range 1-1; P = 0.002) than the non-EACA group. There was no significant difference in the first postoperative 24-hour surgical drain output between the two groups.

Conclusion: EACA, administered at the recommended dosing regimen, is associated with decreased calculated blood loss, RBC transfusion requirements, and intraoperative blood donor exposures.