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Can RoTEM® analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?

Published online by Cambridge University Press:  24 May 2011

Jo Bønding Andreasen ,
Anne-Mette Hvas ,
Kirsten Christiansen  and
Hanne Berg Ravn
Jo Bønding Andreasen*
Affiliation:
Department of Anaesthesiology and Intensive Care, Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark
Anne-Mette Hvas
Affiliation:
Department of Clinical Biochemistry, Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark
Kirsten Christiansen
Affiliation:
Department of Clinical Biochemistry, Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark
Hanne Berg Ravn
Affiliation:
Department of Anaesthesiology and Intensive Care, Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark
*
Correspondence to: Dr J. B. Andreasen, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. Tel: +45 8949 8750; Fax: +45 8949 8809; E-mail: [email protected]
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Abstract

Background

Successful management of bleeding disorders after congenital heart surgery requires detection of specific coagulation disturbances. Whole-blood rotation thromboelastometry (RoTEM®) provides continuous qualitative haemostatic profiles, and the technique has shown promising results in adult cardiac surgery.

Setting

To compare the performance of RoTEM® with that of conventional coagulation tests in children, we conducted a descriptive study in children undergoing congenital cardiac surgery. For that purpose, 60 children were enrolled and had blood samples taken before, immediately after, and 1 day after surgery. Conventional coagulation tests included: activated partial thromboplastin time, prothrombin time, fibrinogen, fibrin D-dimer, thrombin clotting time, factor XIII, and platelet count.

Results

Post-surgical haemostatic impairment was present to some degree in all children, as seen by pronounced changes in activated partial thromboplastin time, prothrombin time, thrombin clotting time, and platelet count, as well as RoTEM® analysis. RoTEM® showed marked changes in clotting time – prolonged by 7–18% – clot formation time – prolonged by 46–71% – maximum clot firmness – reduced by 10–19%, and maximum velocity – reduced by 29–39%. Comparison of the two techniques showed that conventional coagulation tests and RoTEM® performed equally well with regard to negative predictive values for excessive post-operative drain production – more than 20 millilitres per kilogram per 24 hours after surgery – with an area under the curve of approximately 0.65.

Conclusion

RoTEM® can detect haemostatic impairments in children undergoing cardiac surgery and the method should be considered as a supplement in the perioperative care of the children where targeted transfusion therapy is necessary to avoid volume overload.

Keywords

Childrencoagulationthromboelastometrybleeding
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 6 , 28 October 2011 , pp. 684 - 691
Copyright
Copyright © Cambridge University Press 2011

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