title: Thromboelastometry-guided intraoperative haemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery.
abstract: BACKGROUND
  Thromboelastometric evaluation of coagulation might be useful for prediction and management of bleeding after paediatric cardiac surgery. We tested the hypothesis that the use of a thromboelastometry-guided algorithm for blood product management reduces blood loss and transfusion requirements.
  
  
  METHODS
  We studied 78 patients undergoing paediatric cardiac surgery with cardiopulmonary bypass (CPB) for the initial 12 h after operation. Stepwise multiple linear regression was used to develop an algorithm to guide blood product transfusions. Thereafter, we randomly assigned 100 patients to conventional or algorithm-guided blood product management, and assessed bleeding and red cell transfusion requirements.
  
  
  RESULTS
  CPB time, post-bypass rotational thromboelastometry (ROTEM(®)) EXTEM amplitude at 10 min (A10), and FIBTEM-A10 were independently associated with chest tube drainage volume during the initial 12 h after operation. Discriminative analysis determined cut-off values of 30 mm for EXTEM-A10 and 5 mm for FIBTEM-A10, and estimated optimal intraoperative fresh-frozen plasma and platelet concentrate transfusion volumes. Thromboelastometry-guided post-bypass blood product management significantly reduced postoperative bleeding (9 vs 16 ml kg(-1), P<0.001) and packed red cell transfusion requirement (11 vs 23 ml kg(-1), P=0.005) at 12 h after surgery, and duration of critical care stay (60 vs 71 h, P=0.014).
  
  
  CONCLUSIONS
  Rotational thromboelastometry-guided early haemostatic intervention by rapid intraoperative correction of EXTEM-A10 and FIBTEM-A10 reduced blood loss and red cell transfusion requirements after CPB, and reduced critical care duration in paediatric cardiac surgical patients.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry UMIN000006832 (December 4, 2011).
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakayama
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan nakajima@koto.kpu-m.ac.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Department of Anaesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Tanaka
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Maeda
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Iida
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ogawa
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mizobe
mesh_terms: D001777:Blood Coagulation / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013916:Thrombelastography / Q000379:methods*
chemical_list: D006490:Hemostatics
keywords: blood coagulation; blood coagulation tests; blood transfusion; paediatrics