| Abstract |
Background
Rotational thromboelastometry (ROTEM) assesses the hemostatic profile of patients by evaluating the viscoelastic properties of the thrombus formed. It is applied in cases of high risk of bleeding, such as cardiac surgery, trauma, liver transplantation, childbirth and hereditary and acquired bleeding disorders and directs, based on an algorithm, the need for transfusions of blood derivatives or other hemostatic agents, at the right dose and at the right time. It contributes to greater patient safety, as it becomes bedridden, the results are readily available and allows the rapid modification of the treatment according to needs. The perioperative factors affecting hemostasis in cardiac surgery with extracorporeal circulation circuit are many, while bleeding is a major cause of morbidity and mortality in these patients.
Objective
The present study aims to study the effect of the application of Thromboelastometry (ROTEM) on the perioperative strategy of blood transfusion/derivatives and concentrates in patients undergoing scheduled cardiac surgery, as well as to compare the results with the period before its use using traditional transfusion protocols.
Methods
Single-center retrospective observational study in patients over 18 years of age who underwent scheduled cardiac surgery from 2017-2022 at PAGNI. Two groups of patients were compared before and after using ROTEM. Patient demographics, comorbidity, medication, cardiac surgery data, such as type and duration, were recorded. The complications that arose were recorded, laboratory tests, transfusions with blood derivatives, the administration of specialized preparations (tranexamate, fibrinogen, prothrombin, protamine, etc. ) and finally the outcome, such as the duration of hospitalization in ICU, hospital and mortality. The data were processed qualitatively and quantitatively with the corresponding statistical models. The statistical analysis was done with the statistical program IBM SPSS Statistics 29. 0. The level of statistical significance: p < 0. 05
Results
A total of 100 patients were included in the study, with an average age of 64. 1±10. 5 years, a BMI of 28. 5±4. 2, males of 83%. 50. Patients in the ROTEM group were 50 and in the pre- ROTEM group 50, with no differences in their basic characteristics. All interventions were planned and performed by the same KRDX team. The use of ROTEM was accompanied by a decrease in the number of concentrated red blood units administered intraoperatively (p<0. 001), and a decrease in patients receiving PLTs (p<0. 001) and FFPs (p=0. 004) postoperatively. In the ROTEM group, a significant reduction in chest bleeding event (p&llt;0. 001) was observed. Surviving patients in the ROTEM group were transfused with fewer RBC units intraoperatively and postoperatively (p<0. 001), fewer FFP units (p<0. 001), while fewer patients received FFP (p<0. 001) and PLTs (p<0. 001). The average duration of hospitalization in ICU was 3. 75±2. 4 days and in hospital 9. 8±3. 2 days. Patients in the ROTEM group had shorter duration of hospitalization in the ICU (3 vs 4. 5 days, p=0. 002) and hospital (8. 7 vs 10. 9 days, p<0. 001) compared to the pre-ROTEM group. Mortality at 30 days and 6 months was not associated with ROTEM application. Independent predictors of mortality within 30 days of cardiac surgery were older age (p<0. 001), greater number of RBC transfusion units (p=0. 011), thrombocytopenia (p=0. 001), history of coronary artery disease (p=0. 007), as well as the occurrence of ARDS complications (p=0. 001) and chest haemorrhage (p=0. 002) during ICU hospitalization.
Conclusion
Patients who used the ROTEM-directed transfusion strategy received fewer RBC, FFP, and PLT transfusions perioperatively, had fewer complications related to chest bleeding, and had shorter ICU and hospital stays.
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