Rapid thrombelastography predicts perioperative massive blood transfusion in patients undergoing coronary artery bypass grafting

Abstract

Massive blood transfusion (MBT) is a relatively common complication of cardiac surgery, which is independently associated with severe postoperative adverse events. However, the value of using rapid thrombotomography (r-TEG) to predict MBT in perioperative period of cardiac surgery has not been explored. This study aimed to identify the effect of r-TEG in predicting MBT for patients undergoing coronary artery bypass grafting (CABG). This retrospective study included consecutive patients first time undergoing CABG at the Zhongnan Hospital of Wuhan University between March 2015 and November 2017. All the patients had done r-TEG tests before surgery. The MBT was defined as receiving at least 4 units of red blood cells intra-operatively and 5 units postoperatively (1 unit red blood cells from 200 mL whole blood). Lower preoperative hemoglobin level ( P = .001) and longer cardiopulmonary bypass time ( P = .001) were the independent risk factors for MBT during surgery, and no components of the r-TEG predicted MBT during surgery. Meanwhile, longer activated clotting time ( P < .001), less autologous blood transfusion ( P = .001), and older age ( P = .008) were the independent risk factors for MBT within 24 hours of surgery. Preoperative r-TEG activated clotting time can predict the increase of postoperative MBT in patients undergoing CABG. We recommend the careful monitoring of coagulation system with r-TEG, which allows rapid diagnosis of coagulation abnormalities even before the start of surgery.

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

“…4 Despite the clinical significance of acute hemorrhage due to its life-threatening characteristics and the need for urgent preparation of massive transfusion to enable optimal management, the development of a prediction model for massive transfusion during surgery is lacking. Several studies have tried to predict massive transfusion during specific types of high-risk procedures, such as liver transplantation, [5][6][7] cardiac surgery, [8][9][10] placenta previa, 11,12 and spine surgery, 13 but the performances of the prediction models were low, with an area under the receiver operating characteristic curve (AUROC) of 0.65 to 0.84. These low predictive powers may originate from the fact that models developed in previous studies were solely based on preoperative factors without incorporating dynamic intraoperative parameters.…”

Five-minute test to prevent postcardiotomy reexploration

“…Because reexploration is a contributor to adverse outcomes, 5 , 6 , 7 , 8 , 9 cardiac surgeons have continued to revise their surgical techniques, and numerous studies have addressed the optimal postoperative management to reduce postcardiotomy bleeding. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 However, estimating postcardiotomy bleeding is difficult, because it is generally evaluated subjectively by cardiac surgeons. Thus, we attempted to objectively estimate postcardiotomy bleeding during cardiac surgery.…”

“… 1 , 2 , 3 , 4 Postcardiotomy reexploration is associated with adverse outcomes, prolonged intensive care unit (ICU) stay, the requirement for an intra-aortic balloon pump, 3 arrhythmias, 5 deep sternal wound infections, 6 , 7 higher mortality rate, longer mechanical ventilation time, higher rate of blood transfusion, 8 and higher costs. 9 To reduce postcardiotomy bleeding complications, many previous studies have reported attempts to prevent the need for reexploration and to reduce the amount of bleeding and blood product consumption after cardiac surgery by adjusting medications 10 , 11 , 12 , 13 or improving perioperative management 14 , 15 , 16 , 17 , 18 ; however, to the best of our knowledge, there is no established methodology for estimating the amount of excessive postcardiotomy bleeding during cardiac surgery. We developed the 5-minute test (FMT), in which the amount of bleeding during cardiac operation is recorded before chest closure.…”