Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective,...

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Hemostasis and Thrombosis

Background:

• Aortic surgical procedures involving hypothermic circulatory arrest are linked to hemostatic disturbances and increased bleeding.
• Managing transfusion requirements in these complex surgeries is critical for patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a thromboelastometry-guided algorithm in reducing transfusion needs during aortic surgery with hypothermic circulatory arrest.
• To compare transfusion requirements between a thromboelastometry-guided group and a standard care group.

Main Methods:

• A randomized clinical trial involving 56 patients undergoing aortic surgery with hypothermic circulatory arrest.
• Patients were allocated to either a thromboelastometry-guided transfusion algorithm group (n=27) or a control group (n=29) receiving routine transfusion practices.
• The primary endpoint was the cumulative number of allogeneic blood units transfused (red blood cells, fresh-frozen plasma, platelets).

Main Results:

• The thromboelastometry group showed a significant reduction in allogeneic blood transfusion (median 9.0 units vs. 16.0 units, P=0.02).
• A notable decrease in fresh-frozen plasma use was observed (median 3.0 units vs. 8.0 units, P=0.005).
• The thromboelastometry-guided algorithm significantly decreased the need for massive perioperative transfusion (OR, 0.45; P=0.03).

Conclusions:

• Thromboelastometry-guided transfusion effectively reduces the use of allogeneic blood products in patients undergoing aortic surgery with circulatory arrest.
• This strategy is associated with a lower incidence of massive perioperative transfusions, improving patient management.