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Updated: May 15, 2026
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective
Birgitta S Romlin1, Håkan Wåhlander, Mats Synnergren
1Department of Pediatric Anesthesia and Intensive Care, Queen Silvia's Children Hospital, Gothenburg, Sweden.
Insights
Thromboelastometry analysis during cardiopulmonary bypass (CPB) can be accelerated. Analyzing clot firmness after 10 minutes provides reliable results for pediatric cardiac surgery patients, enabling earlier detection of coagulopathy.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hematology
- Pediatric Surgery
Background:
- Pediatric cardiac surgery involving cardiopulmonary bypass (CPB) can induce coagulopathy, potentially leading to postoperative complications.
- Early detection of coagulopathy is crucial for initiating timely countermeasures.
- Modified rotational thromboelastometry (ROTEM) is a valuable tool for assessing hemostasis.
Purpose of the Study:
- To evaluate the predictive value of thromboelastometry (TEM) analysis before weaning from CPB and hemoconcentration for post-CPB results.
- To determine if clot firmness analysis after 10 minutes yields reliable results.
- To assess the feasibility of accelerating TEM analysis in pediatric cardiac surgery.
Main Methods:
- A prospective observational study included 56 pediatric cardiac surgery patients.
- HEPTEM and FIBTEM assays were analyzed during and after CPB with modified ultrafiltration.
- Key parameters measured included clotting time (CT), clot formation time (CFT), clot firmness after 10 min (A10), and maximum clot firmness (MCF).
Main Results:
- Hemoconcentration significantly increased hematocrit.
- TEM variables during and after CPB showed high correlations (r = 0.61–0.82, P < 0.001).
- HEPTEM and FIBTEM A10 measurements during CPB strongly correlated with MCF and were predictable, suggesting reliability for early assessment.
Conclusions:
- Intraoperative TEM analyses can be expedited by performing HEPTEM/FIBTEM analysis before hemoconcentration.
- Analyzing clot firmness (A10) as early as 10 minutes provides reliable results.
- Accelerated TEM analysis can facilitate earlier detection and management of coagulopathy in pediatric cardiac surgery.
Objective:
Earlier detection of coagulopathy in pediatric cardiac surgery patients.
Aim:
To determine whether thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post-CPB results and whether analysis of clot firmness already after 10 min yields reliable results.
Background:
Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. METHODS/MATERIAL: Fifty-six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry (ROTEM). The analyses were compared, and correlations and differences were calculated.
Results:
Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM-CT and HEPTEM-MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: -8.2 mm (-8.9 to -7.5); FIBTEM: -0.5 mm (-0.7 to -0.3).
Conclusion:
The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.
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