Intraoperative thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery.
BACKGROUND
The majority of pediatric cardiac surgery patients receive blood transfusions. We hypothesized that the routine use of intraoperative thromboelastometry to guide transfusion decisions would reduce the overall proportion of patients receiving transfusions in pediatric cardiac surgery.


METHODS
One hundred pediatric cardiac surgery patients were included in the study. Fifty patients (study group) were prospectively included and compared with 50 procedure- and age-matched control patients (control group). In the study group, thromboelastometry, performed during cardiopulmonary bypass, guided intraoperative transfusions. Intraoperative and postoperative transfusions of packed red blood cells, fresh frozen plasma, platelets, and fibrinogen concentrates, and postoperative blood loss and hemoglobin levels were compared between the 2 groups.


RESULTS
The proportion of patients receiving any intraoperative or postoperative transfusion of packed red blood cells, fresh frozen plasma, platelets, or fibrinogen concentrates was significantly lower in the study group than in the control group (32 of 50 [64%] vs 46 of 50 [92%], respectively; P < 0.001). Significantly fewer patients in the study group received transfusions of packed red blood cells (58% vs 78%, P = 0.032) and plasma (14% vs 78%, P < 0.001), whereas more patients in the study group received transfusions of platelets (38% vs 12%, P = 0.002) and fibrinogen concentrates (16% vs 2%, P = 0.015). Neither postoperative blood loss nor postoperative hemoglobin levels differed significantly between the study group and the control group.


CONCLUSIONS
The results suggest that routine use of intraoperative thromboelastometry in pediatric cardiac surgery to guide transfusions is associated with a reduced proportion of patients receiving transfusions and an altered transfusion pattern.
Department of Paediatric Anaesthesia and Intensive Care, Queen Silvia's Children Hospital, 416 85 Gothenburg, Sweden. birgitta.romlin@vgregion.se
Birgitta S
BS
Romlin
Håkan
H
Wåhlander
Håkan
H
Berggren
Mats
M
Synnergren
Fariba
F
Baghaei
Krister
K
Nilsson
Anders
A
Jeppsson
D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*