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A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery
Aymen N Naguib1, Sergio A Carrillo2, Marco Corridore1
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA.
The Journal of Extra-Corporeal Technology
|June 28, 2023
Summary
Rotational thromboelastometry (ROTEM®) use in neonatal and infant cardiac surgery reduced the need for platelets and cryoprecipitate. This targeted approach shows promise for optimizing blood product administration in pediatric cardiac procedures.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Point-of-Care Diagnostics
Background:
- Neonates and infants undergoing cardiac surgery often require substantial blood product volumes.
- Rotational thromboelastometry (ROTEM®) has demonstrated efficacy in reducing blood product use in adult cardiac surgery.
- A need exists to optimize blood product administration in pediatric cardiac surgery.
Purpose of the Study:
- To implement and evaluate a ROTEM®-guided algorithm for targeted blood product administration.
- To reduce blood product utilization during and after neonatal and infant cardiac surgery.
- To assess the impact of ROTEM® on transfusion practices in pediatric cardiac procedures.
Main Methods:
- Retrospective review of a control group (n=28) and prospective data collection using a ROTEM® algorithm (n=40).
- Patients underwent congenital cardiac surgery with cardiopulmonary bypass.
- Data included demographics, surgical details, blood product volumes, ROTEM® parameters, and coagulation profiles.
Main Results:
- No significant differences in patient demographics or procedure complexity between groups.
- ROTEM® group received significantly fewer intraoperative platelets (36 vs. 49 mL/kg, p=0.028).
- ROTEM® group received significantly less cryoprecipitate (8 vs. 15 mL/kg, p=0.001).
Conclusions:
- ROTEM® utilization may lead to significant reductions in specific blood product administration.
- ROTEM®-guided transfusion strategies can play a role in optimizing blood product use in neonatal and infant cardiac surgery.
- Further research can validate these findings and refine ROTEM® protocols for pediatric cardiac surgery.
