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The role of thromboelastography in directing blood product usage in infant open heart surgery
Eric N Mendeloff1, George F Glenn, Paul Tavakolian
1From the *Medical City Dallas Children's Hospital; †Cardiopulmonary Research Science and Technology Institute; ‡Medical City Dallas Hospital, Dallas, TX USA.
Insights
Thromboelastography (TEG) improved blood product use and hemostasis in infants undergoing heart surgery. This analysis shows TEG guides targeted therapy, reducing complications and enhancing patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hematology
Background:
- Thromboelastography (TEG) assesses whole blood clot dynamics, guiding blood product therapy.
- Infants undergoing open heart surgery require precise hemostasis management.
Purpose of the Study:
- To evaluate the impact of TEG implementation on blood product utilization and hemostasis in infants (≤6 months) undergoing open heart surgery.
- To compare outcomes between infants managed with TEG and a historical control group (pre-TEG).
Main Methods:
- Retrospective analysis of 112 infants undergoing open heart surgery within 6 months of life, with 70 historical controls (pre-TEG).
- TEG parameters (R, angle, MA) and blood product usage were recorded intraoperatively.
- Operative parameters and chest tube drainage were monitored postoperatively.
Main Results:
- TEG implementation led to increased intraoperative fresh frozen plasma use (4.74 vs. 1.83 mL/kg) and decreased postoperative platelet (1.69 vs. 3.74 mL/kg) and cryoprecipitate (0.89 vs. 1.95 mL/kg) usage.
- Significantly reduced chest tube drainage was observed at 1, 2, and 24 hours in the TEG group.
- Cyanotic infants' fibrinogen and platelets showed greater sensitivity to hemodilution compared to acyanotic infants.
Conclusions:
- TEG enables proactive, goal-directed blood component therapy in pediatric cardiac surgery.
- Implementation of TEG improves postoperative hemostasis and reduces blood product transfusion in infants undergoing cardiopulmonary bypass.
Objective:
: Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery.
Methods:
: TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG).
Results:
: Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group.TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients.
Conclusions:
: TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.
