Effect of rotational thromboelastometry-guided bleeding management in bilateral lung transplantation

Blood transfusion is often necessary during and after lung transplantation surgery. Point-of-care guided bleeding strategies, such as rotational thromboelastometry (ROTEM), can reduce blood transfusion in cardiovascular surgery. This study aimed to assess the effect of ROTEM-guided bleeding management on the need for allogenic blood transfusion, prohemostatic medication, and clinical outcomes in lung transplantation patients.

This single-center retrospective cohort study compared patients receiving bilateral lung transplantation between 2010-2014 and 2017-2020. The first cohort was treated with a clinically guided bleeding strategy and the second cohort with a ROTEM-guided bleeding strategy. Multivariable regression analyses were performed to determine the effects on primary outcomes.

A total of 167 (66 clinically guided vs 101 ROTEM-guided) patients were included for analysis. Baseline, intraoperative, and postoperative characteristics were mostly similar, but differed regarding the number of patients with cystic fibrosis, use of cardiopulmonary bypass, and surgical technique. The ROTEM-guided group received significantly less median red blood cells (7 [3; 13] vs 4 [1; 9] units, p < 0.01), platelet concentrate (2 [0; 3] vs 0 [0; 2] units, p = 0.01), and plasma volume (2,310 [1,320; 3,960] vs 800 [0; 1,600] ml, p < 0.01). In multivariable regression analysis, implementation of the ROTEM strategy only remained significantly associated with a decreased use of plasma volume. Cardiopulmonary bypass significantly increased allogenic blood transfusion needs. Moreover, more prothrombin complex concentrate, fibrinogen concentrate, and less tranexamic acid were used in the ROTEM-guided group.

ROTEM-guided bleeding management reduces plasma transfusion in bilateral lung transplant surgery and cardiopulmonary bypass seems to increase transfusion needs.