Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial.
OBJECTIVE
Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements.


METHODS
Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused.


RESULTS
Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis.


CONCLUSIONS
Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.
Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. evagird@centras.lt
Evaldas
E
Girdauskas
Jörg
J
Kempfert
Thomas
T
Kuntze
Michael A
MA
Borger
Jörg
J
Enders
Jens
J
Fassl
Volkmar
V
Falk
Friedrich-Wilhelm
FW
Mohr
D000328:Adult; D000368:Aged; D000465:Algorithms; D001011:Aorta / Q000601:surgery*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D005260:Female; D005858:Germany; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013916:Thrombelastography; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*