Effect of an assessment of fibrin-based rotational thromboelastometry on blood transfusion and clinical outcomes in cardiovascular surgery: A cohort study |
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| Institution: | 1. Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organization of Occupational Health and Safety, Hamamatsu, Japan;2. Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan;1. Anaesthesia Department, Hospital Universitari Bellvitge, Spain;2. Anaesthesia Department, Hospital Clinic de Barcelona, IDIBAPS, Spain;3. Hepatology Department, Hospital Clinic Barcelona, Spain;4. Anaesthesia Department, Hospital Reina Sofia, Spain;5. Anaesthesia Department, Hospital Vall d’Hebron, Spain;6. Anaesthesia Department, Hospital Clínico Universitario Virgen de la Arrixaca, Spain;7. Anaesthesia Department, Hospital de Cruces, Spain;8. Anaesthesia Department, Complejo Hospitalario Universitario A Coruña, Spain;9. Anaesthesia Department, Hospital Universitario Gregorio Marañón de Madrid, Spain;10. Anaesthesia Department, Hospital Universitario de Badajoz, Spain;11. Anaesthesia Department, Hospital Universitario de la Fe, Spain;12. University of Barcelona, IDIBELL, Spain;1. Department of Surgery, University of Colorado, Aurora, Colorado;2. Department of Surgery, Denver Health Medical Center, Denver, Colorado;3. Department of Pediatrics, University of Colorado, Aurora, Colorado;4. Bonfils Blood Center, Denver, Colorado;5. University of Colorado School of Public Health, University of Colorado, Aurora, Colorado;1. Clinic for Anesthesiology and Intensive Care Medicine, Franziskus Hospital, Kiskerstraße 26, D-33615 Bielefeld, Germany;2. Duke University School of Medicine, Durham, NC, USA;3. St Michael''s Hospital University of Toronto, Toronto, ON, Canada;4. Helsinki University Hospital, Helsinki, Finland;5. Papworth Hospital, Cambridge, UK;6. Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic;7. Kobe University Hospital, Kobe, Japan;8. Nagoya University Graduate School of Medicine, Nagoya, Japan;9. CSL Behring, Marburg, Germany;10. CSL Behring, King of Prussia, PA, USA;11. University Hospital of Southampton, Southampton, UK |
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| Abstract: | The clinical importance of viscoelastic testing in patient blood management when performing cardiovascular surgery is increasing. We aimed to examine the effect of a blood transfusion protocol including an assessment of fibrin-based rotational thromboelastometry on transfusion volume, mortality, and bleeding complications in patients undergoing cardiac or thoracic aortic surgery. We retrospectively studied a cohort of 376 consecutive patients who underwent cardiopulmonary bypass before (control group: 150 cardiac and 35 thoracic aortic surgeries) and after (assessment group: 154 cardiac and 37 thoracic aortic surgeries) introducing the fibrin polymerization assessment with thromboelastometry in the blood transfusion protocol. The transfusion volume and clinical outcomes were compared between the control and assessment groups, and the standardized (mean) difference (SM]D) was calculated as an indicator of statistical effect size. Compared with the control group, the assessment group had a lower total blood transfusion volume (mL) in cardiac (2720 ± 1282 vs. 2034 ± 1330, p < 0.0001, SMD] = 0.68) and thoracic aortic surgeries (5236 ± 2732 vs. 3714 ± 1768, p < 0.0001, SMD = 0.67). The 1-year mortality rates were 1.9 % and 2.7 % in cardiac and thoracic aortic surgeries, respectively. Significant differences were not observed in the 1-year mortality (3.2 % vs. 1.0 %, p = 0.16, relative risk RR] = 0.32 with 95 % confidence intervals CI] = 0.06–1.57, SD = 0.15), re-exploration for bleeding (4.8 % vs. 2.6 %, p = 0.28, RR = 0.53 with 95 % CI = 0.18–1.57, SD = 0.12), and major bleeding (17.3 % vs. 13.0 %, p = 0.31, RR = 0.75 with 95 % CI = 0.46–1.22, SD = 0.12) rates between the control and assessment groups. The assessment of fibrin polymerization with thromboelastometry using the blood transfusion protocol reduced the blood transfusion volume in cardiovascular surgery. |
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| Keywords: | Thoracic surgery Thromboelastometry Mortality Hemorrhage Blood transfusion |
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