title: Validation of rotational thromboelastometry during cardiopulmonary bypass: A prospective, observational in-vivo study.
abstract: BACKGROUND
  Rotational thromboelastometry (ROTEM) is a whole blood point-of-test used to assess the patient's coagulation status. Three of the available ROTEM tests are EXTEM, INTEM and HEPTEM. In the latter, heparinase added to the INTEM reagent inactivates heparin to reveal residual heparin effect. Performing ROTEM analysis during cardiopulmonary bypass (CPB) might allow the anaesthesiologist to anticipate the need for blood products.
  
  
  OBJECTIVE
  The goal of this study was to validate ROTEM analysis in the presence of very high heparin concentrations during CPB.
  
  
  METHODS
  Prospective, observational trial.
  
  
  METHODS
  Single University Hospital.
  
  
  METHODS
  Twenty patients undergoing coronary artery bypass grafting.
  
  
  METHODS
  ROTEM analysis was performed before heparin administration (T0), 10 min after heparin (T1), at the end of CPB (T2) and 10 min after protamine (T3). The following tests were performed: EXTEM, INTEM, and HEPTEM. Heparin concentrations were measured at T1 and at the end of bypass (T2).
  
  
  RESULTS
  At T1, EXTEM differed from baseline for coagulation time: +26.7 s (18.4 to 34.9, P < 0.0001), α: -3° (1.0 to 5.4, P = 0.006) and A10: -4.4 mm (2.3 to 6.5, P = 0.0004). INTEM at T0 was different from HEPTEM at T1 for coagulation time: + 47 s (34.3 to 59.6, P > 0.0001), A10: -2.3 mm (0.5 to 4.0, P = 0.01) and α -2° (1.0 to 3.0; P = 0.0007). At T2, all parameters in EXTEM and HEPTEM related to fibrin-platelet interaction deteriorated significantly compared to T1. At T3, EXTEM and INTEM were comparable to EXTEM and HEPTEM at T2.
  
  
  CONCLUSIONS
  HEPTEM and EXTEM measurements are valid in the presence of very high heparin concentrations and can be performed before protamine administration in patients undergoing cardiac surgery with CPB.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01455454.
authors.affiliation: From the Department of Anaesthesiology (FG, AP, CMM, PS, CM), Department of Cardiac Surgery (EF, JF, MC), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gronchi
authors.forename: Anouk
authors.initials: A
authors.lastname: Perret
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.forename: Carine M
authors.initials: CM
authors.lastname: Marcucci
authors.forename: Jérome
authors.initials: J
authors.lastname: Flèche
authors.forename: Monique
authors.initials: M
authors.lastname: Crosset
authors.forename: Patrick
authors.initials: P
authors.lastname: Schoettker
authors.forename: Carlo
authors.initials: C
authors.lastname: Marcucci
mesh_terms: D000368:Aged; D000465:Algorithms; D000776:Anesthesiology / Q000379:methods*; D000818:Animals; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass / Q000379:methods*; D065427:Factor Xa Inhibitors; D005260:Female; D006487:Hemostasis; D006493:Heparin / Q000627:therapeutic use*; D006494:Heparin Antagonists / Q000494:pharmacology; D019763:Heparin Lyase / Q000737:chemistry; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use*; D012399:Rotation; D013552:Swine; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
chemical_list: D065427:Factor Xa Inhibitors; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin; D019763:Heparin Lyase