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Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study.

Artikel i vetenskaplig tidskrift
Författare Birgitta S Romlin
Håkan Wåhlander
Mats Johansson-Synnergren
Fariba Baghaei
Anders Jeppsson
Publicerad i Paediatric anaesthesia
Volym 23
Nummer/häfte 3
Sidor 222-7
ISSN 1460-9592
Publiceringsår 2013
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 222-7
Språk en
Länkar dx.doi.org/10.1111/pan.12116
Ämnesord pediatric cardiac surgery, hemostasis;thromboelastometry, coagulopathy, hemoconcentration
Ämneskategorier Kardiologi

Sammanfattning

Objective Earlier detection of coagulopathy in pediatric cardiac surgery patients. Aim To determine whether thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post-CPB results and whether analysis of clot firmness already after 10 min yields reliable results. Background Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. Methods/Material Fifty-six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry (ROTEM®). The analyses were compared, and correlations and differences were calculated. Results Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM-CT and HEPTEM-MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: −8.2 mm (−8.9 to −7.5); FIBTEM: −0.5 mm (−0.7 to −0.3). Conclusion The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.

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