title: Comparison of three point-of-care testing devices to detect hemostatic changes in adult elective cardiac surgery: a prospective observational study.
abstract: BACKGROUND
  Bleeding complications in cardiac surgery may lead to increased morbidity and mortality. Traditional blood coagulation tests are not always suitable to detect rapid changes in the patient's coagulation status. Point-of-care instruments such as the TEG (thromboelastograph) and RoTEM (thromboelastometer) have been shown to be useful as a guide for the clinician in the choice of blood products and they may lead to a reduction in the need for blood transfusion, contributing to better patient blood management.
  
  
  METHODS
  The purpose of this study was to evaluate the ability of the TEG, RoTEM and Sonoclot instruments to detect changes in hemostasis in elective cardiac surgery with cardiopulmonary bypass and to investigate possible correlations between variables from these three instruments and routine hematological coagulation tests. Blood samples from thirty-five adult patients were drawn before and after surgery and analyzed in TEG, RoTEM, Sonoclot and routine coagulation tests. Data were compared using repeated measures analysis of variance and Pearson's test for linear correlation.
  
  
  RESULTS
  We found significant changes for all TEG variables after surgery, for three of the RoTEM variables, and for one variable from the Sonoclot. There were significant correlations postoperatively between plasma fibrinogen levels and variables from the three instruments.
  
  
  CONCLUSIONS
  TEG and RoTEM may be used to detect changes in hemostasis following cardiac surgery with CPB. Sonoclot seems to be less suitable to detect such changes. Variables from the three instruments correlated with plasma fibrinogen and could be used to monitor treatment with fibrinogen concentrate.
authors.affiliation: Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway.
authors.forename: Aurora
authors.initials: A
authors.lastname: Espinosa
authors.affiliation: Department of Cardiothoracic Anesthesia and Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway ; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Roar
authors.initials: R
authors.lastname: Stenseth
authors.affiliation: Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway ; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Videm
authors.affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway ; Clinic of Anaesthesia and Intensive Care, St. Olav University Hospital, Trondheim, Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Pleym
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000627:therapeutic use; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D013916:Thrombelastography / Q000295:instrumentation* / Q000379:methods*
chemical_list: D005340:Fibrinogen
keywords: Blood; Cardiac surgery; Cardiopulmonary bypass (CPB); Coagulation; Thromboelastography; Thromboelastometry