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Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study
Author(s) -
Romlin Birgitta S.,
Wåhlander Håkan,
Synnergren Mats,
Baghaei Fariba,
Jeppsson Anders
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12116
Subject(s) - thromboelastometry , medicine , hemoconcentration , coagulopathy , cardiac surgery , cardiopulmonary bypass , hematocrit , anesthesia , prospective cohort study , observational study , confidence interval , cardiology
Summary Objective Earlier detection of coagulopathy in pediatric cardiac surgery patients. Aim To determine whether thromboelastometry ( TEM ) analysis before weaning from cardiopulmonary bypass ( CPB ) and hemoconcentration is predictive of post‐ CPB results and whether analysis of clot firmness already after 10 min yields reliable results. Background Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. Methods/Material Fifty‐six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time ( CT ), clot formation time ( CFT ), and clot firmness after 10 min (A10) and at maximum ( MCF ) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry ( ROTEM ® ). The analyses were compared, and correlations and differences were calculated. Results Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% ( P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM ‐ CT and HEPTEM ‐ MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF ( P < 0.001 for both), but the correlations were highly significant ( HEPTEM : r = 0.95, P < 0.001; FIBTEM : r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals ( HEPTEM : −8.2 mm (−8.9 to −7.5); FIBTEM : −0.5 mm (−0.7 to −0.3). Conclusion The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM / FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.