ABSTRACT
Objectives
Viscoelastic hemostatic assays such as rotational thromboelastometry (ROTEM®) are
increasingly used in cardiac surgery to guide transfusion decisions. After separation
from cardiopulmonary bypass (CPB), achieving hemostasis rapidly is the main goal prior
to chest closure. We hypothesized that the introduction of a ROTEM-guided factor concentrates
transfusion algorithm will reduce the duration from cardiopulmonary bypass separation
to chest closure during cardiac transplantation.
Design
Retrospective cohort study of 21 patients before and 28 patients after implementation
of ROTEM-guided transfusion algorithm who underwent cardiac transplantation.
Setting
Single-center study conducted at Saint Paul's Hospital, Vancouver BC Canada.
Interventions
The use of ROTEM-guided factor concentrates transfusion algorithm for cardiac transplant
recipients.
Measurement and Main Results
The primary outcome was duration from cardiopulmonary bypass separation to chest closure
analyzed using Mann Whitney U tests. Secondary outcomes included were the volume of postoperative chest tube drainage,
pRBC transfusion requirements within 24 hours of surgery, incidence of adverse events,
and length of stay, before and after introduction of ROTEM-guided factor concentrates
transfusion algorithm. After adjusting for confounders using multivariable linear
regression analysis, the use of a ROTEM-guided factor concentration transfusion algorithm
resulted in a significant decrease in time from CPB separation to skin closure or
39.4 minutes (-73.1 to 123.5 min, p = 0.016). For the secondary outcomes, the use
ROTEM-guided transfusion showed reductions in pRBC transfusion within 24 hours of
surgery (-1.3 units, -2.7 to 0.1 units; p=0.077), and chest tube bleeding (-0.44 ml,
-0.96 to +0.083 ml; p=0.097); however, neither were statistically significant after
adjustment. The median total hospital length of stay in the study group was lower
by 3 days (13 days vs. 16) days; p= 0.048).
Conclusion
The introduction of a ROTEM-guided factor concentrates transfusion algorithm was associated
with a significant reduction in time to chest closure after separation from cardiopulmonary
bypass. While it reduced the total hospital length of stay, there was no difference
in mortality, major complications, or ICU length of stay.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
