Rotational thromboelastometry (ROTEM) in pediatric intensive care: A single center experience

Area of Science:

• Pediatric Critical Care Medicine
• Hemostasis and Thrombosis
• Point-of-Care Testing

Background:

• Rotational thromboelastometry (ROTEM) is a viscoelastic hemostasis analysis tool used in intensive care.
• Its impact on transfusion practices and correlation with standard coagulation tests in critically ill pediatric patients, particularly those on extracorporeal membrane oxygenation (ECMO), requires further investigation.

Purpose of the Study:

• To analyze the impact of ROTEM on transfusion practices in critically ill pediatric patients.
• To investigate the correlation between standard coagulation tests and ROTEM parameters (EXTEM, INTEM, FIBTEM).
• To assess the utility of ROTEM in guiding transfusion therapy for pediatric ECMO patients.

Main Methods:

• Retrospective descriptive study utilizing single-center data from January 2021 to February 2023.
• Included 26 critically ill pediatric patients in the Pediatric Intensive Care Unit (PICU) who underwent ROTEM analysis.
• Propensity score matching compared 14 ECMO patients receiving ROTEM-guided transfusions with 14 ECMO patients who did not.

Main Results:

• No significant difference in transfusion requirements was observed between ROTEM-guided and non-ROTEM-guided ECMO patients.
• No significant correlation was found between standard coagulation tests and ROTEM's EXTEM and INTEM parameters.
• A moderate positive correlation was identified between FIBTEM maximum clot firmness (MCF) and fibrinogen levels (R² = 0.304).

Conclusions:

• ROTEM analysis did not significantly alter transfusion practices in this cohort of critically ill pediatric patients.
• FIBTEM MCF demonstrates a potential for rapid, indirect assessment of fibrinogen levels in intensive care settings.
• The findings suggest ROTEM may not be essential for guiding transfusions in all pediatric intensive care scenarios but highlights its potential for fibrinogen assessment.