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.
Retrospective cohort study of 21 patients before and 28 patients after implementation of ROTEM-guided transfusion algorithm who underwent cardiac transplantation.
Single-center study conducted at Saint Paul's Hospital, Vancouver BC Canada.
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).
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.
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