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. 2022 Apr;82(2):143-149.
doi: 10.1080/00365513.2022.2034038. Epub 2022 Feb 3.

Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery

Isabel Rodríguez-Martín  1 , Catalina Sánchez-Mora  1 , Antonio R Fernández-López  2 , Francisco J González-Fernández  3 , Juan Carlos Téllez-Cantero  4 , Verónica Blanco-Marquez  2 , Mariano García de la Borbolla  4 , Juan C Santos-Jiménez  4 , Concepción González-Rodríguez  1 , José Garnacho-Montero  3 , Víctor Sánchez-Margalet  1
Affiliations

Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery

Isabel Rodríguez-Martín et al. Scand J Clin Lab Invest. 2022 Apr.

Abstract

Background: Viscoelastic tests (rotational thromboelastometry, ROTEM®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

Methods: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM® implementation.

Results: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p = .026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p = .002), fresh frozen plasma (9.8% vs 3.8%, p = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p = .599) and activated recombinant factor VII (0.3% vs 0.0%, p = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p = .530) and fibrinogen concentrate (0.9% vs 3.5%, p = .066), tranexamic acid (0.0% vs 0.6%, p = .370) and protamine administration (0.6% vs 0.9%, p = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p = .037), surgical reexploration (6.0% vs 2.9%, p = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p = .026).

Conclusions: The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

Keywords: Cardiac surgery; ROTEM; cardiopulmonary bypass; coagulopathy; hemostasis; thromboelastometry.

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