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Monitoring of coagulation status using thrombelastography during paediatric open heart surgery
P Martin1, F Horkay, S M Rajah
1Department of Cardiothoracic Surgery, Killingbeck Hospital, Leeds, England.
Insights
Thrombelastography (TEG) effectively identified children at risk for bleeding after heart surgery. This viscoelastic hemostatic assay showed high accuracy in predicting postoperative hemorrhage, aiding clinical decision-making.
Area of Science:
- Cardiology
- Hematology
- Pediatric Surgery
Background:
- Thrombelastography (TEG) assesses coagulopathies by measuring clot elasticity.
- Its utility in pediatric cardiac surgery remains undefined.
- Coagulopathies can complicate open heart procedures in children.
Purpose of the Study:
- To evaluate the role of TEG in identifying coagulopathies in pediatric patients undergoing open heart surgery.
- To correlate TEG parameters with postoperative blood loss and hematological indices.
- To assess TEG's predictive accuracy for postoperative hemorrhage.
Main Methods:
- Twenty-two pediatric patients undergoing open heart surgery were studied.
- TEG was performed preoperatively, post-protamine, and at 2 and 24 hours postoperatively.
- Patients were grouped by 24-hour blood loss (<0.7 ml/kg/h vs. >0.7 ml/kg/h).
Main Results:
- Group 2 (higher blood loss) showed a significant correlation between post-protamine MA phase and platelet count (r=0.93, p<0.001).
- Elevated blood loss in Group 2 was linked to prolonged K phase and diminished MA phase compared to preoperative values.
- TEG predicted increased postoperative bleeding with 100% accuracy (8/8) and 73% specificity (8/11).
Conclusions:
- TEG parameters, particularly K and MA phases, are altered in pediatric cardiac surgery patients with significant postoperative blood loss.
- TEG shows promise as a tool for predicting postoperative hemorrhage in this population.
- Further evaluation of TEG alterations as markers for postoperative bleeding is warranted.
Abstract:
Thrombelastography (TEG) has proved useful in identifying coagulopathies (via assessment of clot elasticity properties) during hepatic surgery, but its role in cardiac surgery has as yet not been defined. Twenty-two children [11M, 11F, mean age (range) 4.9 (0.1-16) years] undergoing open heart surgery were investigated [1] preoperatively, [2] 15 min post protamine, [3] 2 h and [4] 24 h postoperatively using TEG. Comparisons were made between pre- and postoperative measurements and haematological indices. The values obtained from the TEG were: R phase (indicative of thrombokinase and thrombin formation disorders), K phase (indicative of fibrinogenesis) and MA phase (providing information on clot stability and platelet function). The patients were divided into two groups based upon 24 h blood loss; Group 1 - blood loss less than 0.7 ml/kg/h and Group 2 - blood loss greater than 0.7 ml/kg/h. In Group 2 there was a highly significant correlation between post-protamine MA phase and platelet number (r = 0.93, p less than 0.001) but there was no correlation in Group 1 (p greater than 0.1). Furthermore, in Group 2 elevated postoperative blood loss was associated with a prolonged K phase (mean [SD] 12.0 [6.0] versus 6.3 [2.1] min, p less than 0.05) and diminished MA phase (37 [12.5] versus 56 [4.9] mm, p less than 0.01) relative to preoperative values. In Group 1, K and MA phase did not alter significantly (p greater than 0.5 and p greater than 0.2, respectively). TEG predicted with 100% (8/8) accuracy increased post-operative bleeding. The specificity of TEG prediction of future bleeding was 73% [8/11]. Alterations in TEG parameters merit further evaluation as markers of postoperative haemorrhage.