Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study

This retrospective, observational study compared the impact of a point-of-care rotational thromboelastometry (ROTEM ® ) method versus conventional bleeding management in terms of postoperative (24-h) blood loss, intraoperative and postoperative (24-h) transfusion requirement and length of stay in th...

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Bibliographic Details
Published in:	Journal of anesthesia Vol. 31; no. 2; pp. 286 - 290
Main Authors:	Vasques, Francesco, Spiezia, Luca, Manfrini, Alberto, Tarzia, Vincenzo, Fichera, Dario, Simioni, Paolo, Gerosa, Gino, Ori, Carlo, Di Gregorio, Guido
Format:	Journal Article
Language:	English
Published:	Tokyo Springer Japan 01-04-2017 Springer
Subjects:	Aged Anesthesiology Blood Transfusion Cardiac patients Cardiac Surgical Procedures - methods Cardiopulmonary Bypass - methods Comparative analysis Coronary artery bypass Critical Care Medicine Emergency Medicine Female Fibrin Fibrinogen Fibrinogen - administration & dosage Humans Intensive Male Medicine Medicine & Public Health Middle Aged Pain Medicine Postoperative Hemorrhage - epidemiology Postoperative Period Retrospective Studies Short Communication Thrombelastography - methods Thromboelastometry Adult Cardiac surgery Bleeding ROTEM
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Summary:	This retrospective, observational study compared the impact of a point-of-care rotational thromboelastometry (ROTEM ® ) method versus conventional bleeding management in terms of postoperative (24-h) blood loss, intraoperative and postoperative (24-h) transfusion requirement and length of stay in the postoperative intensive care unit (ICU) in patients undergoing cardiac surgery. Forty consecutive patients undergoing cardiac surgery under ROTEM ® -guided hemostatic management were enrolled; the control population included 40 selected patients undergoing similar interventions without ROTEM ® monitoring. Significantly more patients in the thromboelastometry group versus the control group received fibrinogen (45 vs 10 %; p < 0.0001), while fewer received a transfusion (40 vs 72.5 %; p < 0.0033). Compared with control group patients, those in the thromboelastometry group had less postoperative bleeding (285 vs 393 mL; p < 0.0001), a shorter time from cardiopulmonary bypass discontinuation to skin suture (79.3 vs 92.6 min; p = 0.0043) and a shorter stay in the ICU (43.7 vs 52.5 h; p = 0.0002). In our preliminary experience, ROTEM ® -guided bleeding management was superior to conventional management of bleeding in patients undergoing complex cardiac surgery with cardiopulmonary bypass in terms of reduced postoperative blood loss, transfusion requirement, and length of ICU stay.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0913-8668 1438-8359
DOI:	10.1007/s00540-016-2271-5