title: Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study.
abstract: OBJECTIVE
  Earlier detection of coagulopathy in pediatric cardiac surgery patients.
  
  
  OBJECTIVE
  To determine whether thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post-CPB results and whether analysis of clot firmness already after 10 min yields reliable results.
  
  
  BACKGROUND
  Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. METHODS/MATERIAL: Fifty-six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry (ROTEM). The analyses were compared, and correlations and differences were calculated.
  
  
  RESULTS
  Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM-CT and HEPTEM-MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: -8.2 mm (-8.9 to -7.5); FIBTEM: -0.5 mm (-0.7 to -0.3).
  
  
  CONCLUSIONS
  The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.
authors.affiliation: Department of Pediatric Anesthesia and Intensive Care, Queen Silvia's Children Hospital, Gothenburg, Sweden.
authors.forename: Birgitta S
authors.initials: BS
authors.lastname: Romlin
authors.forename: Håkan
authors.initials: H
authors.lastname: Wåhlander
authors.forename: Mats
authors.initials: M
authors.lastname: Synnergren
authors.forename: Fariba
authors.initials: F
authors.lastname: Baghaei
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
mesh_terms: D000768:Anesthesia, General; D000925:Anticoagulants / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D016343:Monitoring, Intraoperative; D010976:Platelet Count; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D014462:Ultrafiltration
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins