Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients
Abstract Introduction Rotational thromboelastometry (ROTEM) has been shown to reduce the need for transfused blood products in adult and pediatric cardiac surgery patients. However, similar evidence in newborns, neonates, and young infants is lacking. We quantified ROTEM value changes in pediatric p...
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doaj-acd4063b864c4943943ad024ef310db22020-11-25T02:56:03ZengBMCJournal of Cardiothoracic Surgery1749-80902019-07-011411910.1186/s13019-019-0949-0Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patientsChristopher F. Tirotta0Richard G. Lagueruela1Daria Salyakina2Weize Wang3Thomas Taylor4Jorge Ojito5Kathleen Kubes6Hyunsoo Lim7Robert Hannan8Redmond Burke9Department of Anesthesia, The Heart Program, Nicklaus Children’s HospitalDepartment of Anesthesia, The Heart Program, Nicklaus Children’s HospitalResearch Institute, Nicklaus Children’s HospitalResearch Institute, Nicklaus Children’s HospitalResearch Institute, Nicklaus Children’s HospitalDepartment of Cardiac Surgery, The Heart Program, Nicklaus Children’s HospitalDepartment of Cardiac Surgery, The Heart Program, Nicklaus Children’s HospitalDepartment of Cardiac Surgery, The Heart Program, Nicklaus Children’s HospitalDepartment of Cardiac Surgery, The Heart Program, Nicklaus Children’s HospitalDepartment of Cardiac Surgery, The Heart Program, Nicklaus Children’s HospitalAbstract Introduction Rotational thromboelastometry (ROTEM) has been shown to reduce the need for transfused blood products in adult and pediatric cardiac surgery patients. However, similar evidence in newborns, neonates, and young infants is lacking. We quantified ROTEM value changes in pediatric patients on cardiopulmonary bypass (CPB) before, during and after blood product transfusion. Methods Each surgery had at least four interventions: initiating CPB; platelet administration during rewarming phase; post-CPB and following protamine and human fibrinogen concentrate (HFC) administration; and further component therapy if bleeding persisted and ROTEM indicated a deficiency. ROTEM assays were performed prior to surgery commencement, on CPB prior to platelet administration and following 38 mL/kg platelets, and post-CPB after protamine and HFC administration. ROTEM assays were also performed in the post-CPB period after further blood component therapy administration. Results Data from 161 patients were analyzed. Regression models suggested significant changes in HEPTEM clotting time after all interventions. PLT administration during CPB improved HEPTEM α by 22.1° (p < 0.001) and FIBTEM maximum clot firmness (MCF) by 2.9 mm (p < 0.001). HFC administration after CPB termination significantly improved FIBTEM MCF by 2.6 mm (p < 0.001). HEPTEM MCF significantly increased after 3/4 interventions. HEPTEM α significantly decreased after two interventions and significantly increased after two interventions. Greatest perturbances in coagulation parameters occurred in patients ≤90 days of age. Conclusion CPB induced profound perturbations in ROTEM values in pediatric cardiac surgery patients. ROTEM values improved following PLT and HFC administration. This study provides important clinical insights into ROTEM changes in pediatric patients after distinct interventions.http://link.springer.com/article/10.1186/s13019-019-0949-0ROTEMFibrinogenRiaSTAPNeonatesInfantsCardiac surgery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christopher F. Tirotta Richard G. Lagueruela Daria Salyakina Weize Wang Thomas Taylor Jorge Ojito Kathleen Kubes Hyunsoo Lim Robert Hannan Redmond Burke |
spellingShingle |
Christopher F. Tirotta Richard G. Lagueruela Daria Salyakina Weize Wang Thomas Taylor Jorge Ojito Kathleen Kubes Hyunsoo Lim Robert Hannan Redmond Burke Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients Journal of Cardiothoracic Surgery ROTEM Fibrinogen RiaSTAP Neonates Infants Cardiac surgery |
author_facet |
Christopher F. Tirotta Richard G. Lagueruela Daria Salyakina Weize Wang Thomas Taylor Jorge Ojito Kathleen Kubes Hyunsoo Lim Robert Hannan Redmond Burke |
author_sort |
Christopher F. Tirotta |
title |
Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients |
title_short |
Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients |
title_full |
Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients |
title_fullStr |
Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients |
title_full_unstemmed |
Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients |
title_sort |
interval changes in rotem values during cardiopulmonary bypass in pediatric cardiac surgery patients |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2019-07-01 |
description |
Abstract Introduction Rotational thromboelastometry (ROTEM) has been shown to reduce the need for transfused blood products in adult and pediatric cardiac surgery patients. However, similar evidence in newborns, neonates, and young infants is lacking. We quantified ROTEM value changes in pediatric patients on cardiopulmonary bypass (CPB) before, during and after blood product transfusion. Methods Each surgery had at least four interventions: initiating CPB; platelet administration during rewarming phase; post-CPB and following protamine and human fibrinogen concentrate (HFC) administration; and further component therapy if bleeding persisted and ROTEM indicated a deficiency. ROTEM assays were performed prior to surgery commencement, on CPB prior to platelet administration and following 38 mL/kg platelets, and post-CPB after protamine and HFC administration. ROTEM assays were also performed in the post-CPB period after further blood component therapy administration. Results Data from 161 patients were analyzed. Regression models suggested significant changes in HEPTEM clotting time after all interventions. PLT administration during CPB improved HEPTEM α by 22.1° (p < 0.001) and FIBTEM maximum clot firmness (MCF) by 2.9 mm (p < 0.001). HFC administration after CPB termination significantly improved FIBTEM MCF by 2.6 mm (p < 0.001). HEPTEM MCF significantly increased after 3/4 interventions. HEPTEM α significantly decreased after two interventions and significantly increased after two interventions. Greatest perturbances in coagulation parameters occurred in patients ≤90 days of age. Conclusion CPB induced profound perturbations in ROTEM values in pediatric cardiac surgery patients. ROTEM values improved following PLT and HFC administration. This study provides important clinical insights into ROTEM changes in pediatric patients after distinct interventions. |
topic |
ROTEM Fibrinogen RiaSTAP Neonates Infants Cardiac surgery |
url |
http://link.springer.com/article/10.1186/s13019-019-0949-0 |
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