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Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study

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Abstract

This retrospective, observational study compared the impact of a point-of-care rotational thromboelastometry (ROTEM®) method versus conventional bleeding management in terms of postoperative (24-h) blood loss, intraoperative and postoperative (24-h) transfusion requirement and length of stay in the postoperative intensive care unit (ICU) in patients undergoing cardiac surgery. Forty consecutive patients undergoing cardiac surgery under ROTEM®-guided hemostatic management were enrolled; the control population included 40 selected patients undergoing similar interventions without ROTEM® monitoring. Significantly more patients in the thromboelastometry group versus the control group received fibrinogen (45 vs 10 %; p < 0.0001), while fewer received a transfusion (40 vs 72.5 %; p < 0.0033). Compared with control group patients, those in the thromboelastometry group had less postoperative bleeding (285 vs 393 mL; p < 0.0001), a shorter time from cardiopulmonary bypass discontinuation to skin suture (79.3 vs 92.6 min; p = 0.0043) and a shorter stay in the ICU (43.7 vs 52.5 h; p = 0.0002). In our preliminary experience, ROTEM®-guided bleeding management was superior to conventional management of bleeding in patients undergoing complex cardiac surgery with cardiopulmonary bypass in terms of reduced postoperative blood loss, transfusion requirement, and length of ICU stay.

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Authors and Affiliations

  1. Anesthesiology and Intensive Care Unit, Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Via Cesare Battisti 267, 35121, Padua, Italy

    Francesco Vasques, Alberto Manfrini & Carlo Ori

  2. Department of Medicine, Thrombophilia and Hemophilia Center, University of Padua, Padua, Italy

    Luca Spiezia & Paolo Simioni

  3. Institute of Anesthesia and Intensive Care, Azienda Ospedaliera di Padova, Padua, Italy

    Carlo Ori & Guido Di Gregorio

  4. Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy

    Vincenzo Tarzia, Dario Fichera & Gino Gerosa

Authors
  1. Francesco Vasques
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  2. Luca Spiezia
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  3. Alberto Manfrini
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  4. Vincenzo Tarzia
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  5. Dario Fichera
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  6. Paolo Simioni
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  7. Gino Gerosa
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  8. Carlo Ori
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  9. Guido Di Gregorio
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Correspondence to Francesco Vasques.

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Conflict of interest

The authors declare no conflicts of interest relevant to the study. This study was not economically supported. The authors thank Ray Hill, an independent medical writer, who provided language editing and journal styling prior to submission. This assistance was supported by CSL Behring, Italy.

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Vasques, F., Spiezia, L., Manfrini, A. et al. Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study. J Anesth 31, 286–290 (2017). https://doi.org/10.1007/s00540-016-2271-5

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  • DOI: https://doi.org/10.1007/s00540-016-2271-5

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