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Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery
1Department of Anaesthesia, University Children’s Hospital Zurich, Steinwiesstrasse 75, Zurich 8032, Switzerland. thorsten.haas@kispi.uzh.ch
Insights
Rotational thromboelastometry (ROTEM®) offers faster results than standard coagulation tests for pediatric surgery. While ROTEM® assays correlate well with fibrinogen levels, they are not interchangeable with prothrombin time (PT) or activated partial thromboplastin time (aPTT).
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Laboratory Medicine
Background:
- Intraoperative coagulation disorders are a concern in pediatric surgery.
- Rotational thromboelastometry (ROTEM®) may aid in early detection.
- This study compares ROTEM® to standard coagulation tests.
Purpose of the Study:
- To compare ROTEM® with standard coagulation tests in pediatric surgery.
- To evaluate the correlation between ROTEM® assays and standard tests.
- To assess the turnaround time of ROTEM® compared to standard tests.
Main Methods:
- Observational trial involving intraoperative blood sampling in children undergoing major elective surgery.
- Simultaneous analysis of standard coagulation tests (PT, aPTT, fibrinogen) and ROTEM® assays (InTEM, ExTEM, FibTEM).
- Performed by trained hospital laboratory staff.
Main Results:
- A total of 288 samples from 50 subjects were analyzed.
- Good correlation between fibrinogen level and FibTEM assay (r=0.882, P<0.001).
- ROTEM® results were available significantly faster (23 min) than standard tests (53 min).
Conclusions:
- ROTEM® clotting time (CT) is not interchangeable with PT or aPTT.
- ROTEM® results may provide a more accurate assessment of coagulation status than standard tests.
- ROTEM® offers a significant advantage in rapid turnaround time for intraoperative coagulation monitoring.
Background:
Thromboelastometry (ROTEM(®)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests.
Methods:
Intraoperative blood sampling was obtained in children undergoing elective major surgery. At each time point, standard coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen level] and ROTEM(®) analyses (InTEM, ExTEM, and FibTEM) were performed simultaneously by trained hospital laboratory staff.
Results:
A total of 288 blood samples from 50 subjects were analysed. While there was a poor correlation between PT and aPTT to ExTEM clotting time (CT) and InTEM CT, respectively, a good correlation was detected between PT and aPTT to clot formation time, and a very good correlation between fibrinogen level and FibTEM assay (r=0.882, P<0.001). Notably, 64% of PT and 94% of aPTT measurements were outside the reference range, while impaired CT was observed in 13% and 6.3%, respectively. Standard coagulation test results were available after a median of 53 min [inter-quartile range (IQR): 45-63 min], whereas 10 min values of ROTEM(®) results were available online after 23 min (IQR: 21-24 min).
Conclusions:
PT and aPTT cannot be interchangeably used with ROTEM(®) CT. Based on the results of ROTEM(®), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(®) offered faster turnaround times.
