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Br J Anaesth. 2015 Jan;114(1):91-102. doi: 10.1093/bja/aeu339. Epub 2014 Oct 10.

Thromboelastometry-guided intraoperative haemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery.

Author information

1
Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
2
Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan nakajima@koto.kpu-m.ac.jp.
3
Department of Anaesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
4
Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

CLINICAL TRIAL REGISTRATION:

UMIN Clinical Trials Registry UMIN000006832 (December 4, 2011).

KEYWORDS:

blood coagulation; blood coagulation tests; blood transfusion; paediatrics

PMID:
25303988
DOI:
10.1093/bja/aeu339
[Indexed for MEDLINE]
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