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 andtransfusion 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 transfusionvolumes. Thromboelastometry-guided post-bypass blood product management significantly reduced postoperative bleeding (16-9 ml kg-1, P<0.001) and packed red cell transfusion requirement (23-11 ml kg-1, P=0.005) at 12 h after surgery, and duration of critical care stay (from 71 to 60 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).