Rotational thromboelastometry (ROTEM) in pediatric intensive care: A single center experience

Abstract

The study aimed to analyze ROTEM's impact on transfusion practices and investigate the correlation between standard coagulation tests and ROTEM parameters. We designed it as a retrospective descriptive study, using single-center data from January 2021 to February 2023. All critically ill children admitted to PICU who underwent ROTEM analysis as part of their diagnostic and therapeutic management were included in the study. During the analysis period, ROTEM testing was performed on a total of 26 pediatric patients in our PICU, more than half of whom were ECMO patients. To evaluate the impact of ROTEM-guided transfusion on ECMO patients, a control group of ECMO patients who did not receive ROTEM-guided transfusions during the same period was utilized. Propensity score matching, based on baseline characteristics, was employed to create comparable groups of 14 ECMO patients each. The analysis revealed no significant difference in transfusion requirements between those who received ROTEM-guided therapy and those who did not. While no correlation was found between traditional coagulation tests and ROTEM's EXTEM and INTEM parameters, a moderate positive correlation was observed between FIBTEMMCF and fibrinogen levels. A regression model demonstrated that for every unit increase in FIBTEM-MCF, fibrinogen levels increased by 0.046 g/L, accounting for approximately 30.4 % of the variability. The study may encourage clinicians to use ROTEM in the intensive care. Additionally, our linear regression model shows a significant relationship between FIBTEM-MCF and fibrinogen levels. The predictiveformula we have demonstrated may improve clinical decision-making by providing a rapid predictive method to assess coagulation status.

Keywords: ECMO; Pediatric critical care; ROTEM; Transfusion.