Predictive Value of Intraoperative Thromboelastometry for the Risk of Perioperative Excessive Blood Loss in Infants and Children Undergoing Congenital Cardiac Surgery: A Retrospective Analysis

Kim, Eun‐Hee; Shim, Haeng Seon; Lee, Sue Young; Park, Sun Kyung; Yang, Ji Hyuk; Jun, Gyuchan Thomas; Kim, Chung Su

doi:10.1053/j.jvca.2016.03.132

Cited by 19 publications

(23 citation statements)

References 45 publications

(16 reference statements)

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“…Bias from unknown or unmeasured confounders may have influenced the results. For example, intraoperative blood loss volume should be obtained from gauze count, discard suction volume (except irrigation fluid volume), chest tube output at the end of surgery and total intraoperative volume of salvaged red blood cells [46]. However, it is difficult to measure all these variables routinely in the OR and using the recorded blood loss volume in the study may carry a significant error.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

et al. 2016

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Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (<12 months) [odds ratio (OR), 4.01; 95% confidence interval (CI), 1.77–9.06], longer cardiopulmonary bypass (CPB) time (OR, 2.45; 95% CI, 1.24–4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07–5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23–19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33–20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

et al. 2016

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“…First, this is a descriptive study with a surrogate (i.e., without a clinical) endpoint. However, as this surrogate endpoint has been correlated with relevant clinical endpoints in the past [64][65][66][67][68] and recently [69][70][71], it should allow generation of solid hypotheses to lay basis for further clinical studies. Also, this is a single center study, and the results may therefore be influenced by local specifics.…”

Section: Discussionmentioning

confidence: 99%

Factor XIII Deficiency and Thrombocytopenia Are Frequent Modulators of Postoperative Clot Firmness in a Surgical Intensive Care Unit

Rappard¹,

Hinnen²,

Lussmann³

et al. 2017

Transfus Med Hemother

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Objective: Fibrinogen and factor XIII (FXIII) have been shown to critically influence clot firmness in the intraoperative setting and thus likely influence intraoperative bleeding. We were interested to identify potential modulators of postoperative clot firmness in a tertiary care hospital surgical intensive care unit setting, independent of their clinical course during surgery. Methods: 272 day-shift consecutive patients were evaluated for whole blood clot firmness evaluated by the ROTEM® EXTEM thrombelastometric assay and various potential modulators of clot firmness upon arrival at the surgical intensive care unit (SICU). Results: Maximum clot firmness on the SICU was found to be independently influenced by the amount of colloids given during surgery as well as by platelet count, fibrinogen concentration, and FXIII activity at the time of SICU admission. In patients with lowest clot firmness, FXIII activity was the most important independent modulator of clot firmness; in patients with the highest clot firmness, platelet count and fibrinogen concentration were the most important modulators of clot firmness. Deficiencies (i.e., results below normal range) of these modulators of clot firmness were most prevalent for FXIII (activity < 70%: 45% of cases), which was significantly more frequent than thrombocytopenia (<150 × 10⁹/l: 32%) or fibrinogen deficiency (<1.5 g/l: 6%). Conclusions: Postoperative clot firmness as evaluated by whole blood thrombelastometry (ROTEM EXTEM assay) is independently and frequently modulated though FXIII activity and the platelet count, while fibrinogen concentration is also an independent but much less frequent modulator. Different modulators show different influences, depending on the clot firmness being present. Colloids infused during surgery also independently modulate postoperative clot firmness. Based on our data, strategies can be developed to improving postoperative care of patients with bleedings or at risk for bleeding.

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“…43 Interestingly the findings of the authors' systematic review contrast with the findings from the pediatric cardiac surgery literature, in which thromboelastometry has been found to predict major bleeding. 44,45 This might be explained by the smaller blood volume of children, leading to more hemodilution and coagulopathy by CPB. These hemostatic disturbances as the main cause of major blood loss in children would explain the discrepancy in the predictive value of thromboelastometry compared with adults.…”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis is supported by the fact that the body weight and duration of CPB are the best predictors for massive hemorrhage in pediatric cardiac surgery. [44][45][46] The current cohort study is limited by the small sample size, retrospective data analysis, relative low blood loss and transfusion requirements, and the inclusion of both patients at low and high risk for bleeding. Furthermore, the earliest data from the cohort study date back to 2008.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult Cardiac Surgery: Cohort Study and Systematic Review

Meesters

Burtman

Ven

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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Predictive Value of Intraoperative Thromboelastometry for the Risk of Perioperative Excessive Blood Loss in Infants and Children Undergoing Congenital Cardiac Surgery: A Retrospective Analysis

Cited by 19 publications

References 45 publications

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

Factor XIII Deficiency and Thrombocytopenia Are Frequent Modulators of Postoperative Clot Firmness in a Surgical Intensive Care Unit

Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult Cardiac Surgery: Cohort Study and Systematic Review

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