Thromboelastography-guided Intraoperative Platelet Transfusion in Pediatric Heart Surgery

Area of Science:

• Cardiovascular Surgery
• Hematology
• Pediatric Critical Care

Background:

• Postoperative bleeding is a significant complication in pediatric complex cardiac surgery.
• Thromboelastography (TEG) can guide blood product transfusions to mitigate bleeding risks.
• This study focused on validating a TEG 6S maximum amplitude (TEG-MA)-based platelet transfusion calculator.

Purpose of the Study:

• To validate a TEG 6S maximum amplitude (TEG-MA)-based platelet transfusion calculator.
• To assess the calculator's effectiveness in minimizing postoperative bleeding in pediatric cardiac surgery patients.
• To compare calculator-recommended transfusion volumes with those given at surgical discretion.

Main Methods:

• Retrospective study of 1000 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
• Compared platelet transfusion volumes administered by surgical teams versus those recommended by the TEG-MA calculator.
• Used logistic regression to evaluate the association between transfusion adequacy and postoperative bleeding or thrombosis.

Main Results:

• Lower post-transfusion TEG-MA (≤45 mm) correlated with increased postoperative bleeding risk (OR, 4.4).
• The calculator showed moderate correlation with measured post-transfusion TEG-MA (r=0.7).
• Failure to reach a TEG-MA of ≥45 mm significantly increased bleeding risk (OR, 3.2).

Conclusions:

• Customizing perioperative platelet transfusion with quantitative diagnostic tests like TEG can reduce bleeding complications.
• The validated TEG-MA calculator aids in optimizing platelet transfusion strategies.
• This approach supports safer surgical outcomes for pediatric cardiac patients.