Tirotta Christopher F, Lagueruela Richard G, Salyakina Daria, Wang Weize, Taylor Thomas, Ojito Jorge, Kubes Kathleen, Lim Hyunsoo, Hannan Robert, Burke Redmond
Department of Anesthesia, The Heart Program, Nicklaus Children's Hospital, 3100 S.W. 62nd Street, Miami, FL, 33155, USA.
Research Institute, Nicklaus Children's Hospital, Miami, FL, USA.
J Cardiothorac Surg. 2019 Jul 22;14(1):139. doi: 10.1186/s13019-019-0949-0.
Rotational thromboelastometry (ROTEM) has been shown to reduce the need for transfused blood products in adult and pediatric cardiac surgery patients. However, similar evidence in newborns, neonates, and young infants is lacking. We quantified ROTEM value changes in pediatric patients on cardiopulmonary bypass (CPB) before, during and after blood product transfusion.
Each surgery had at least four interventions: initiating CPB; platelet administration during rewarming phase; post-CPB and following protamine and human fibrinogen concentrate (HFC) administration; and further component therapy if bleeding persisted and ROTEM indicated a deficiency. ROTEM assays were performed prior to surgery commencement, on CPB prior to platelet administration and following 38 mL/kg platelets, and post-CPB after protamine and HFC administration. ROTEM assays were also performed in the post-CPB period after further blood component therapy administration.
Data from 161 patients were analyzed. Regression models suggested significant changes in HEPTEM clotting time after all interventions. PLT administration during CPB improved HEPTEM α by 22.1° (p < 0.001) and FIBTEM maximum clot firmness (MCF) by 2.9 mm (p < 0.001). HFC administration after CPB termination significantly improved FIBTEM MCF by 2.6 mm (p < 0.001). HEPTEM MCF significantly increased after 3/4 interventions. HEPTEM α significantly decreased after two interventions and significantly increased after two interventions. Greatest perturbances in coagulation parameters occurred in patients ≤90 days of age.
CPB induced profound perturbations in ROTEM values in pediatric cardiac surgery patients. ROTEM values improved following PLT and HFC administration. This study provides important clinical insights into ROTEM changes in pediatric patients after distinct interventions.
旋转血栓弹力图（ROTEM）已被证明可减少成人和小儿心脏手术患者输注血液制品的需求。然而，新生儿、婴儿和幼儿中缺乏类似的证据。我们对小儿体外循环（CPB）患者在输注血液制品之前、期间和之后的ROTEM值变化进行了量化。
每次手术至少有四项干预措施：启动CPB；在复温阶段输注血小板；CPB后以及给予鱼精蛋白和人纤维蛋白原浓缩物（HFC）之后；如果持续出血且ROTEM显示有缺陷，则进行进一步的成分治疗。在手术开始前、CPB期间血小板输注前以及输注38 mL/kg血小板后、CPB后给予鱼精蛋白和HFC后进行ROTEM检测。在进一步输注血液成分治疗后的CPB后期也进行了ROTEM检测。
分析了161例患者的数据。回归模型表明，所有干预后HEPTEM凝血时间有显著变化。CPB期间输注血小板使HEPTEM α提高了22.1°（p < 0.001），使FIBTEM最大血凝块硬度（MCF）提高了2.9 mm（p < 0.001）。CPB结束后给予HFC使FIBTEM MCF显著提高了2.6 mm（p < 0.001）。3/4的干预后HEPTEM MCF显著增加。两次干预后HEPTEM α显著降低，两次干预后显著增加。凝血参数的最大扰动发生在年龄≤90天的患者中。
CPB在小儿心脏手术患者中引起ROTEM值的显著扰动。输注血小板和HFC后ROTEM值有所改善。本研究为小儿患者在不同干预后的ROTEM变化提供了重要的临床见解。
