Diagnostic Agreement Between TEG5000 and TEG6S in the Assessment of Hemostasis in Pediatric Cardiac Surgery: A Prospective Non-inferiority Study

Benegni, Simona; Giorni, Chiara; Raggi, Valeria; Garisto, Cristiana; Iodice, Francesca Giovanna; Rizza, Alessandra; Marinari, Eleonora; Favia, Isabella; Piga, Simone; Buonomo, Chiara; Di Chiara, Luca; Atti, Maria Luisa Ciofi Degli; Ricci, Zaccaria

doi:10.1007/s00246-023-03311-w

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…In critical care settings, global hemostatic tests can guide diagnosis, management, and outcome prediction in various conditions like cardiac surgery, mechanical circulatory support, and DIC (38–40). Specifically, in pediatric DIC cases, two case reports used CWA to monitor hemostatic changes, and one case report demonstrated thromboelastometry-guided surgery in a girl with neuroblastoma and DIC (31, 32, 41).…”

Section: Discussionmentioning

confidence: 99%

Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand*

Chanthong,

Choed-Amphai,

Manowong

et al. 2024

Pediatric Critical Care Medicine

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Objectives: This study aimed to determine the test performances of rotational thromboelastometry (ROTEM) and activated partial thromboplastin time-based clot waveform analysis (aPTT-CWA) compared with the International Society on Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH-DIC) score for diagnosis of overt disseminated intravascular coagulation (ODIC) in critically ill children. Prognostic indicators of DIC complications were also evaluated. Design: A prospective cross-sectional observational study was conducted. ROTEM and aPTT-CWA were assessed alongside standard parameters based on the ISTH-DIC score and natural anticoagulants. Both conventional and global hemostatic tests were repeated on days 3–5 for nonovert DIC. Setting: PICU of the Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Subjects: Infants and children who were admitted to PICU with underlying diseases predisposed to DIC, such as sepsis, malignancy, major surgery, trauma, or severe illness, were included in the study between July 1, 2021, and November 30, 2022. Interventions: None. Measurements and Main Results: Sixty-four children were enrolled in this study. The prevalence of ODIC was 20.3%. Regarding ROTEM parameters, using EXTEM clot formation time (CFT) cutoff of greater than 102 seconds provided sensitivity and specificity of 90.9% and 80.9%, respectively, for diagnosing ODIC, with the area under the curve (AUC) of 0.86. In the case of aPTT-CWA performance, no biphasic waveform was observed, whereas both maximum coagulation acceleration (Min2) of less than 0.35%/s2 and maximum coagulation deceleration of less than 0.25%/s2 demonstrated identical sensitivities of 76.9% and specificities of 79.6%. Combining two global hemostatic tests significantly improved the diagnostic performance (INTEM CFT + EXTEM CFT + Min2 AUC 0.92 [95% CI, 0.80–1.00] vs. EXTEM CFT AUC 0.86 [95% CI, 0.75–0.96], p = 0.034). Bleeding was the most common consequence. In multivariable logistic regression analysis, Min2 of less than 0.36%/s2 was an independent risk factor for bleeding complications, with an adjusted odds ratio of 15.08 (95% CI, 1.08–211.15, p = 0.044). Conclusions: ROTEM and aPTT-CWA were valuable diagnostic tools in critically ill children who might require point-of-care tests. Min2 showed significant clinical implications for predicting bleeding events in this population.

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Section: Discussionmentioning

confidence: 99%

Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand*

Chanthong,

Choed-Amphai,

Manowong

et al. 2024

Pediatric Critical Care Medicine

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“…Benegni et al assessed agreement between TEG5000 and TEG6s in pediatric cardiac surgery patients. 15 Blood samples at 1 hour and 24 hours postoperatively were compared. Six TEG parameters were analyzed.…”

Section: Transfusion and Hemostasismentioning

confidence: 99%

The Year in Review: Anesthesia for Congenital Heart Disease 2023

Wadle,

Landsem,

Latham

et al. 2024

Semin Cardiothorac Vasc Anesth

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“…31 Another main theme was the mitigation of postcardiopulmonary bypass (CPB) bleeding by different techniques, such as FFP-based prime solutions, more advanced viscoelastic tests, and 4-factor prothrombin complex concentrate. [32][33][34][35] Furthermore, the authors discussed the literature pertinent to intraoperative pharmacology. In a meta-analysis, remote ischemic preconditioning reduced postoperative mechanical ventilation and duration of ICU length of stay with propofolfree anesthesia.…”

Section: Congenital Heart Diseasementioning

confidence: 99%

“…31 Another main theme was the mitigation of post-cardiopulmonary bypass (CPB) bleeding by different techniques, such as FFP-based prime solutions, more advanced viscoelastic tests, and 4-factor prothrombin complex concentrate. 32–35…”

Section: Congenital Heart Diseasementioning

confidence: 99%

A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities

Krause,

Tzeng,

Kertai

et al. 2024

Semin Cardiothorac Vasc Anesth

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Diagnostic Agreement Between TEG5000 and TEG6S in the Assessment of Hemostasis in Pediatric Cardiac Surgery: A Prospective Non-inferiority Study

Cited by 3 publications

References 15 publications

Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand*

Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand*

The Year in Review: Anesthesia for Congenital Heart Disease 2023

A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities

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