Thromboelastometry-guided intraoperative haemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery
- 1 January 2015
- journal article
- research article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 114 (1), 91-102
- https://doi.org/10.1093/bja/aeu339
Abstract
Thromboelastometric evaluation of coagulation might be useful for prediction and management of bleeding after paediatric cardiac surgery. We tested the hypothesis that the use of a thromboelastometry-guided algorithm for blood product management reduces blood loss and transfusion requirements. We studied 78 patients undergoing paediatric cardiac surgery with cardiopulmonary bypass (CPB) for the initial 12 h after operation. Stepwise multiple linear regression was used to develop an algorithm to guide blood product transfusions. Thereafter, we randomly assigned 100 patients to conventional or algorithm-guided blood product management, and assessed bleeding and red cell transfusion requirements. CPB time, post-bypass rotational thromboelastometry (ROTEM(®)) EXTEM amplitude at 10 min (A10), and FIBTEM-A10 were independently associated with chest tube drainage volume during the initial 12 h after operation. Discriminative analysis determined cut-off values of 30 mm for EXTEM-A10 and 5 mm for FIBTEM-A10, and estimated optimal intraoperative fresh-frozen plasma and platelet concentrate transfusion volumes. Thromboelastometry-guided post-bypass blood product management significantly reduced postoperative bleeding (9 vs 16 ml kg(-1), P<0.001) and packed red cell transfusion requirement (11 vs 23 ml kg(-1), P=0.005) at 12 h after surgery, and duration of critical care stay (60 vs 71 h, P=0.014). Rotational thromboelastometry-guided early haemostatic intervention by rapid intraoperative correction of EXTEM-A10 and FIBTEM-A10 reduced blood loss and red cell transfusion requirements after CPB, and reduced critical care duration in paediatric cardiac surgical patients. UMIN Clinical Trials Registry UMIN000006832 (December 4, 2011).Keywords
Funding Information
- Ministry of Education, Culture, Sports, Science and Technology
This publication has 38 references indexed in Scilit:
- ICU Early Physical Rehabilitation ProgramsCritical Care Medicine, 2013
- Tools to Support Interpreting Multiple Regression in the Face of MulticollinearityFrontiers in Psychology, 2012
- First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular SurgeryAnesthesiology, 2011
- A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution‐induced coagulation changes after cardiac surgeryTransfusion, 2011
- FIBTEM provides early prediction of massive transfusion in traumaCritical Care, 2011
- Intraoperative Thromboelastometry Is Associated with Reduced Transfusion Prevalence in Pediatric Cardiac SurgeryAnesthesia & Analgesia, 2011
- Point of care testing in children undergoing cardiopulmonary bypassPediatric Blood & Cancer, 2010
- Antithrombin Deficiency Increases Thrombin Activity After Prolonged Cardiopulmonary BypassAnesthesia & Analgesia, 2008
- Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic reviewJournal of Thrombosis and Haemostasis, 2008
- Basic principles of ROC analysisSeminars in Nuclear Medicine, 1978