title: Comparison between thromboelastography and conventional coagulation tests after cardiopulmonary bypass surgery in the paediatric intensive care unit.
abstract: BACKGROUND
  Following paediatric cardiac surgery using cardiopulmonary bypass (CPB), there is a risk of significant postoperative bleeding. A number of risk factors are associated with postoperative bleeding including; age, complexity of the surgery, dilution and consumption of clotting factors. We conducted a prospective audit comparing different coagulation tests used following paediatric CPB to determine whether thromboelastography (TEG) on the intensive care unit or routine laboratory coagulation assays including fibrinogen are better at assessing bleeding and bleeding risk.
  
  
  METHODS
  Tests on arrival in paediatric intensive care unit (PICU) included the following: fibrinogen, prothrombin time, activated partial thromboplastin time, full blood count and TEG. Bleeding was measured in the first 1-4 h via chest drain loss. Bleeding was considered significant if ≥5 ml/kg/h.
  
  
  RESULTS
  Of 107 patients admitted to PICU, 23/107 were considered to be bleeding during the first hour. Fibrinogen concentration had the best correlation with the amount of first-hour blood loss (r(s) = 0.52), followed by APTT (r(s) = 0.44) and TEG MA (r(s) = 0.34). TEG parameter TEG MA correlated with platelet count (r(s) = 0.68) and fibrinogen (r(s) = 0.66).
  
  
  CONCLUSIONS
  Thromboelastography did not show better correlation with postoperative bleeding than conventional clotting tests. TEG parameter maximum amplitude correlates with platelet count and fibrinogen.
authors: Department of Paediatric Cardiac Intensive Care, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.
authors: J
authors: J
authors: Pekelharing
authors: A
authors: A
authors: Furck
authors: W
authors: W
authors: Banya
authors: D
authors: D
authors: Macrae
authors: S J
authors: SJ
authors: Davidson
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011517:Prothrombin Time; D013916:Thrombelastography
chemical_list: D005340:Fibrinogen
keywords: Paediatric; cardiac surgery; coagulation; thromboelastography