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. 2023 Jun;55(2):60-69.
doi: 10.1051/ject/2023017. Epub 2023 Jun 28.

A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery

Aymen N Naguib  1 , Sergio A Carrillo  2 , Marco Corridore  1 , Amee M Bigelow  3 , Ashley Walczak  2 , Nguyen K Tram  1 , Diane Hersey  2 , Mark Galantowicz  2 , Joseph D Tobias  1
Affiliations

A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery

Aymen N Naguib et al. J Extra Corpor Technol. 2023 Jun.

Abstract

Background: Neonates and infants undergoing cardiac surgery tend to receive high volumes of blood products. The use of rotational thromboelastometry (ROTEM®) has been shown to reduce the administration of blood products in adults after cardiac surgery. We sought to develop a targeted administration of blood products based on ROTEM® to reduce blood product utilization during and after neonatal and infant cardiac surgery.

Methods: We conducted a retrospective review of data from a single center for neonates and infants undergoing congenital cardiac surgery using cardiopulmonary bypass (CPB) from September 2018-April 2019 (control group). Then, using a ROTEM® algorithm, we collected data prospectively between April-November 2021 (ROTEM group). Data collected included age, weight, gender, procedure, STAT score, CPB time, aortic cross-clamp time, volume, and type of blood products administered in the operating room and cardiothoracic intensive care unit (CTICU). In addition, ROTEM® data, coagulation profile in CTICU, chest tube output at 6 and 24 hours, use of factors concentrate, and thromboembolic complications were recorded.

Results: The final cohort of patients included 28 patients in the control group and 40 patients in the ROTEM group. The cohort included neonates and infants undergoing the following procedures: arterial switch, aortic arch augmentation, Norwood procedure, and comprehensive stage II procedure. There were no differences in the demographics or procedure complexity between the two groups. Patients in the ROTEM® group received fewer platelets (36 ± 12 vs. 49 ± 27 mL/kg, p 0.028) and cryoprecipitate (8 ± 3 vs. 15 ± 10 mL/kg, p 0.001) intraoperatively when compared to the control group.

Conclusion: The utilization of ROTEM® may have contributed to a significant reduction in some blood product administration during cardiac surgery for infants and neonates. ROTEM® data may play a role in reducing blood product administration in neonatal and infant cardiac surgery.

Keywords: ROTEM®; bleeding after pediatric cardiac surgery; prothrombin complex concentrate; recombinant factor VIIa.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pre-cardiopulmonary bypass (CPB) algorithm. FFP – fresh frozen plasma; PRBC – packed red blood cells; RAP = retrograde autologous priming; VAP – venous antegrade priming.
Figure 2
Figure 2
Cardiopulmonary bypass intraoperative algorithm.
Figure 3
Figure 3
Post-cardiopulmonary bypass algorithm.
See this image and copyright information in PMC

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