Higher Fibrinogen Concentrations for Reduction of Transfusion Requirements During Major Paediatric Surgery: A Prospective Randomised Controlled Trial

Background Hypofibrinogenaemia is one of the main reasons for development of perioperative coagulopathy during major paediatric surgery. The aim of this study was to assess whether prophylactic maintenance of higher fibrinogen concentrations through administration of fibrinogen concentrate would decrease the volume of transfused red blood cell (RBCs). Methods In this prospective, randomised, clinical trial, patients aged 6 months to 17 yr undergoing craniosynostosis and scoliosis surgery received fibrinogen concentrate (30 mg kg−1) at two predefined intraoperative fibrinogen concentrations [ROTEM® FIBTEM maximum clot firmness (MCF) of Results Thirty children who underwent craniosynostosis surgery and 19 children who underwent scoliosis surgery were treated per protocol. During craniosynostosis surgery, children in the early substitution group received significantly less RBCs (median, 28 ml kg−1; IQR, 21 to 50 ml kg−1) compared with the conventional fibrinogen trigger of Conclusions Intraoperative administration of fibrinogen concentrate using a FIBTEM MCF trigger level of Clinical trial registry number ClinicalTrials.gov NCT01487837.