title: Perioperative monitoring of thromboelastograph on blood protection and recovery for severely cyanotic patients undergoing complex cardiac surgery.
abstract: In this study, we assessed the clinical effect of a new transfusion therapy guided by thromboelastograph (TEG) on blood protection. Thirty-one children with severe cyanosis (hematocrit ≥54%), who were diagnosed as having transposition of the great arteries or double outlet right ventricle with or without pulmonary valve stenosis, and underwent arterial switch operation or double roots transplantation, were involved and were divided into two groups. In group F (n=17), the transfusion therapy after cardiopulmonary bypass was performed with fibrinogen administration combined with traditional transfusion, guided by TEG. In group C (n=14), traditional transfusion guided by clinical experiences only was performed. We observed the blood protection effects and recovery conditions of these patients. In surgery, compared with group C, the chest closure time, fresh-frozen plasma (FFP), and platelet (PLT) volume used at closure time had no significant reductions in group F (P>0.05, respectively), and the patients in group F had no significant reductions in the amount of chest drainage (P>0.05). The total PLT and total red blood cells usage were also the same (P>0.05). But during the first 24h, FFP usage in the intensive care unit (ICU) and total perioperative FFP usage had significantly dropped in group F (P<0.05); the mechanical ventilator time, ICU stay, and hospitalization time in group F were much shorter than those in group C (P<0.05). So, TEG was effective in perioperative blood protection. Fibrinogen could be a substitute for FFP to restore hemostasis and improve the prognosis for these patients.
authors.affiliation: Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fuwai Hospital, CAMS, and PUMS, Beijing, China.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Cui
authors.forename: Feilong
authors.initials: F
authors.lastname: Hei
authors.forename: Cun
authors.initials: C
authors.lastname: Long
authors.forename: Zhengyi
authors.initials: Z
authors.lastname: Feng
authors.forename: Ju
authors.initials: J
authors.lastname: Zhao
authors.forename: Fuxia
authors.initials: F
authors.lastname: Yan
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Wang
authors.forename: Jinping
authors.initials: J
authors.lastname: Liu
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002681:China; D003029:Coagulants / Q000008:administration & dosage*; D003422:Critical Care; D003490:Cyanosis / Q000097:blood / Q000209:etiology / Q000601:surgery*; D005340:Fibrinogen / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007902:Length of Stay; D019990:Perioperative Care; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013916:Thrombelastography; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D005340:Fibrinogen