Thromboelastography Is Associated With Surrogates for Bleeding After Pediatric Cardiac Operations

Area of Science:

• Cardiology
• Pediatric Surgery
• Anesthesiology

Background:

• Perioperative bleeding is a significant complication in pediatric cardiac surgery.
• Thromboelastography (TEG) is underutilized in pediatric cardiac surgery despite its use in adults.
• Limited data exist on TEG's utility in predicting bleeding in pediatric cardiac surgery patients.

Purpose of the Study:

• To investigate the association between TEG variables and postoperative bleeding in pediatric patients undergoing complex cardiac operations.
• To determine if specific TEG parameters can predict the need for blood products or re-exploration due to bleeding.

Main Methods:

• Retrospective study of 511 pediatric patients (≤18 years) undergoing cardiac surgery with cardiopulmonary bypass.
• TEG analysis performed post-protamine and on ICU admission.
• Composite endpoint: extended blood product transfusion or surgical re-exploration for bleeding.

Main Results:

• Lower maximum amplitude (MA) < 45 mm on TEG was significantly associated with the composite bleeding endpoint (52% vs 31%, p < 0.001).
• MA < 45 mm was an independent predictor of the composite endpoint (p < 0.001).
• Intraoperative platelet transfusion in patients with MA < 45 mm reduced subsequent bleeding endpoints (8% vs 24%, p = 0.02).

Conclusions:

• Intraoperative TEG MA < 45 mm is a valuable indicator of bleeding risk in pediatric complex cardiac surgery.
• Prophylactic platelet transfusion in the operating room may mitigate bleeding complications in the ICU for these patients.