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Rotational Thromboelastometry Values After On-Pump Cardiac Surgery - A Retrospective Cohort Study
Maria S Gauger1, Philip Kaufmann1, Firmin Kamber1
1Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Seminars in Cardiothoracic and Vascular Anesthesia
|May 26, 2022
Summary
Rotational thromboelastometry (ROTEM) values after cardiopulmonary bypass differ from standard ranges. ROTEM reliably estimates fibrinogen and platelet levels, unaffected by hematocrit, aiding coagulation management.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Laboratory Medicine
Background:
- Viscoelastic coagulation monitoring is crucial for managing coagulation post-cardiac surgery.
- Optimal target values for viscoelastic monitoring after heparin reversal remain undefined.
Purpose of the Study:
- Determine expected rotational thromboelastometry (ROTEM) values post-heparin reversal.
- Correlate ROTEM parameters with fibrinogen and platelet counts.
- Assess the impact of hemoglobin on ROTEM measurements.
Main Methods:
- Retrospective analysis of 571 adult patients undergoing cardiac surgery with cardiopulmonary bypass.
- ROTEM and laboratory tests performed 5-10 minutes post-protamine administration.
Main Results:
- Prolonged clotting times and reduced clot firmness observed compared to reference ranges.
- Excellent linear correlation between FIBTEM A10/MCF and fibrinogen levels (r=0.81/0.80).
- Significant correlation between ROTEM parameters and platelet counts (r=0.32-0.68); hematocrit had no effect.
Conclusions:
- Post-cardiopulmonary bypass ROTEM values deviate from established reference ranges.
- ROTEM parameters accurately estimate fibrinogen and platelet counts.
- ROTEM measurements are not influenced by hematocrit levels.
