Rotational thromboelastometry reduces blood loss and blood product usage after lung transplantation

Durila, Miroslav; Vajter, Jaromir; Garaj, Michal; Pollert, Lukas; Berousek, Jan; Vachtenheim, J; Vymazal, Tomáš; Lischke, Robert

doi:10.1016/j.healun.2021.03.020

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…The study had to be stopped prematurely in the aftermath of an interim statistical analysis, after including only 67 patients, because the results were significantly in favor of the POCCT-based strategy There was a significant decrease in perioperative blood loss, consumption of RBC, and consumption of fresh frozen plasma without deteriorating clot formation in secondary and primary hemostasis. However, this study had a major bias because patients in the POCCT-based strategy group received a fluid support exclusively with 5% albumin solution, whereas fluid support in the other group was based on crystalloids and colloids [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Fessler

Finet

Fischler

et al. 2022

Life

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The management of lung transplant patients has continued to evolve in recent years. The year 2021 was marked by the publication of the International Consensus Recommendations for Anesthetic and Intensive Care Management of Lung Transplantation. There have been major changes in lung transplant programs over the last few years. This review will summarize the knowledge in anesthesia management of lung transplantation with the most recent data. It will highlight the following aspects which concern anesthesiologists more specifically: (1) impact of COVID-19, (2) future of transplantation for cystic fibrosis patients, (3) hemostasis management, (4) extracorporeal membrane oxygenation management, (5) early prediction of primary graft dysfunction, and (6) pain management.

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Section: Resultsmentioning

confidence: 99%

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Fessler

Finet

Fischler

et al. 2022

Life

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“…The pathology of secondary hemostasis as a cause of perioperative bleeding was ruled out by the ROTEM® results, which did not differ significantly before and after surgery. We have just recently published the data of the original study where it was shown that using ROTEM perioperatively reduces perioperative bleeding and the consumption of blood products during this procedure 29 . Therefore, we use this test as a standard test instead of routine laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

“…We have just recently published the data of the original study where it was shown that using ROTEM perioperatively reduces perioperative bleeding and the consumption of blood products during this procedure. 29 Therefore, we use this test as a standard test instead of routine laboratory tests.…”

Section: F I G U R Ementioning

confidence: 99%

Extracorporeal membrane oxygenation seems to induce impairment of primary hemostasis pathology as measured by a Multiplate analyzer: An observational retrospective study

et al. 2021

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Background: Extracorporeal membrane oxygenation (ECMO) support is often associated with bleeding complications caused by secondary or primary hemostasis pathology. However, there are limited data investigating primary hemostasis using Multiplate aggregometry with specific diagnostics tests for vWF (von Willebrand factor) deficiency. Aims:The aim of this study was to find out whether short-term ECMO produces the pathology of primary hemostasis that is detected by Multiplate aggregometry and to investigate the pathology of vWF.Methods: In this study, blood samples of 20 patients undergoing lung transplantations with short-term perioperative ECMO support were analyzed. The multimeric structure, the levels of von Willebrand factor antigen (vWF), ristocetin cofactor (RCo), collagen-binding protein (CB), and the results of multiple electrode aggregometry RISTO (ristocetin), ADP (adenosine diphosphate), ASPI (Aspirin®; arachidonic acid), and TRAP (thrombin receptor activating peptide) tests were compared to the samples obtained before and after ECMO support. Results:The Multiplate ADP and RISTO tests showed the presence of significant pathology in primary hemostasis after surgery (p < 0.05), suggesting the presence of acquired platelet dysfunction. Although the RISTO tests suggest the presence of acquired vWF deficiency, laboratory tests for vWF antigen and RCo and CB tests showed an increase in this case. The multimeric structure of vWF did not show clinically significant deterioration.Conclusions: Multiple aggregometry ADP, ASPI, and TRAP tests seem to be able to detect primary hemostasis pathology (platelets aggregation and adhesion pathology) that is present during short-term perioperative ECMO support in lung transplantation procedures. Interestingly, RISTO tests seem to be more suitable How to cite this article:

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“…The use of these approaches has been reported in studies on cardiac surgery and liver transplantation [15][16][17]. Previously, we reported that POC-targeted coagulopathy management decreases perioperative blood loss and consumption of RBCs and fresh frozen plasma (FFP) during LuTx [18].…”

Section: Introductionmentioning

confidence: 99%

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

et al. 2023

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Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play an important role in subsequent PGD development. Methods We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. Results Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18–129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105–0.267). After dichotomization of PGD (0–1 vs 2–3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2–3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). Conclusions Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. Trial registration This clinical trial was registered at ClinicalTrials.gov (NCT03598907).

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Rotational thromboelastometry reduces blood loss and blood product usage after lung transplantation

Cited by 15 publications

References 17 publications

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Extracorporeal membrane oxygenation seems to induce impairment of primary hemostasis pathology as measured by a Multiplate analyzer: An observational retrospective study

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

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