Evaluation of rotational thromboelastometry guided coagulation management in adult cardiac surgery

Abstract

Objective: Rotational thronboelastometry (ROTEM) in cardiac surgery was implemented in our centre during 2019. The objectives were to evaluate changes in the administration of blood products and hemostatic drugs, to analyse changes in perioperative complications, economic analysis. Methods: Single-centre retrospective cohort study. Data of adult patients undergoing cardiac surgery in 2018 (group 1) and 2020 (group 2). In group 1 (n = 438), blood products and hemostatic drugs were administered empirically at the anesthesiologist’s discretion. In group 2 (n = 321), blood products and hemostatic drugs were administered according to an algorithm. Results: A significant reduction was observed in the number of patients who received packed red blood cells (PRBC) (19% vs 29.2%; p = 0.001), fresh frozen plasma (FFP) (1.6% vs 7.5%; p < 0.001), fibrinogen concentrate (FC) (23.4% vs 30.6%; p = 0.028) and recombinant activated factor VII (rFVIIa) (0.3% vs 2.7%; p = 0.011). A significant decrease was observed in the total quantity of PRBC, platelet concentrates (PC), FFP, FC and rFVIIa administered per patient. The economic analysis showed a reduction of 30% in the average cost per patient. Conclusions: Thromboelastometry allows a reduction in administration of blood products and hemostatic drugs, in addition to lowering costs. Further studies on the use of viscoelastic tests in cardiac surgery and reductions in morbidity and mortality are required.