Validation of rotational thromboelastometry during cardiopulmonary bypass

Gronchi, Fabrizio; Perret, Amandine; Ferrari, Enrico; Marcucci, Carine; Flèche, Jérome; Crosset, Monique; Schoettker, Patrick; Marcucci, Carlo

doi:10.1097/eja.0b013e328363171a

Cited by 34 publications

(23 citation statements)

References 20 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The decreases in ROTEM results and platelet count after CPB correlate well with previous findings after CPB. 3,18 However, the ROTEM platelet results in our study all decreased significantly compared with pre-bypass values, in contrast to findings where platelet function was tested with the Multiplate-instrument, and only ADP and arachidonic acid-triggered aggregation was significantly decreased after CPB. 11 Our findings regarding a significant increase of TRAP-tem after platelet transfusion may be interpreted with previous findings in mind,…”

Section: Risk Factors For Transfusioncontrasting

confidence: 98%

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Kjellberg

Holm

Lindvall

et al. 2020

Transfusion Medicine

View full text Add to dashboard Cite

Objectives: The aim of this study was to investigate whether ROTEM platelet can provide additional information to the traditional ROTEM analysis to guide treatment with platelet transfusions in cardiac surgery and to identify factors triggering platelet administration. Background: Platelets play a crucial role in coagulation and haemostasis after cardiac surgery. Excessive bleeding after cardiopulmonary bypass usually requires transfusions of blood products, including platelets. The ROTEM platelet is a novel point-ofcare analysis for whole blood. Materials and methods: We included 23 patients scheduled for complex cardiac surgery. ROTEM (in-tem, ex-tem), ROTEM platelet (ARA-tem, ADP-tem and TRAP-tem) and platelet count were analysed before induction of anaesthesia (T0), after cardiopulmonary bypass and protamine reversal (T1) and after platelet transfusion (T2, n = 10). Results: ROTEM and ROTEM platelet tests were all significantly reduced between T0 and T1. ROTEM parameters improved significantly after platelet transfusion. Regarding ROTEM platelet, only TRAP-tem increased between T1 and T2 (P = .008). Factors triggering platelet transfusion were long duration of surgery and time on cardiopulmonary bypass. Conclusion: ROTEM platelet with thrombin activation, TRAP-tem, improved significantly, indicating that platelet transfusion may reverse cardiopulmonary bypassinduced platelet dysfunction. Further studies are needed to evaluate whether TRAPtem can be a valuable analysis regarding indications for transfusion of platelets after extensive cardiac surgery.

show abstract

Section: Risk Factors For Transfusioncontrasting

confidence: 98%

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Kjellberg

Holm

Lindvall

et al. 2020

Transfusion Medicine

View full text Add to dashboard Cite

show abstract

“…Rotational thromboelastometry assay diagnostics utilize citrated whole blood with four independent measuring channels to allow a combination of appropriate assays . The EXTEM assay detects deficiencies of vitamin K‐dependent coagulation factors, fibrinogen, platelets and factor XIII.…”

Section: Methodsmentioning

confidence: 99%

Protocol guided bleeding management improves cardiac surgery patient outcomes

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Here, the extrinsically activated assays EXTEM, FIBTEM, and APTEM contain the heparin inhibitor polybrene that inactivates up to 5 IU/ml unfractionated heparin. This enables the use and interpretation of these assays even under high heparin concentrations, such as on cardiopulmonary bypass (CPB) [50][51][52]. The 'beads' reagents used in the ROTEM sigma cartridges perform in the same way and the results are stored in the database under the terms EXTEM C, FIBTEM C, and APTEM C. Furthermore, the so-called single use reagents (SUR) are available for ROTEM delta and ROTEM platelet (Table 1).…”

Section: Thromboelastometry and Whole Blood Im Pedance Aggregometry Dmentioning

confidence: 99%

“…All HEPTEM assays (LR, SUR, and C [cartridge-based assayfor ROTEM sigma]) contain heparinase that eliminates up to 7 IU/ml heparin and can therefore be used in blood samples with high heparin concentrations [50,51].…”

Section: Thromboelastometry and Whole Blood Im Pedance Aggregometry Dmentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

163

138

View full text Add to dashboard Cite

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration. Fig. 1. ROTEM trace ('temogram') displaying the clinically most important parameters and their informative value. FDPs: fibrin (ogen) split products. Courtesy of Klaus Görlinger, Germany.

show abstract

Validation of rotational thromboelastometry during cardiopulmonary bypass

Abstract: clinicaltrials.gov Identifier: NCT01455454.

Cited by 34 publications

References 20 publications

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Protocol guided bleeding management improves cardiac surgery patient outcomes

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Contact Info

Product

Resources

About