Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.
Department of Haematology, Royal Papworth Hospital, Cambridge, UK.
Anaesthesia. 2020 Mar;75(3):366-373. doi: 10.1111/anae.14942. Epub 2019 Dec 17.
Coagulopathic bleeding during and after cardiac surgery is associated with increased morbidity and mortality. Viscoelastic testing is increasingly used instead of laboratory testing. Our aim was to compare a new viscoelastic point-of-care device, the Quantra System, with thromboelastography and standard laboratory testing. After ethical approval and with written informed consent, we prospectively recruited adult patients undergoing urgent cardiac surgery at increased risk of bleeding. Clot time and clot stiffness values were compared before, during and after cardiopulmonary bypass. We prospectively recruited 52 patients, of whom 34 (65%) were transfused with red blood cells. Our usual transfusion thresholds for fibrinogen (1.5 g.l ), platelets (100,000.μl ), prothrombin time (20 s), activated partial thromboplastin time (48 s) and maximum amplitude on thromboelastography (50 mm) corresponded to Quantra values of fibrinogen clot stiffness 2.0 hPa, platelet clot stiffness 13.5 hPa, clot time 159 s, clot time 183 s and clot stiffness 17.0 hPa, respectively. These Quantra thresholds showed high negative predictive value for low platelets (platelet clot stiffness, 97.4%), prolonged activated partial thromboplastin time (clot time, 92.6%) and reduced maximum amplitude on thromboelastography (clot stiffness, 93.6%). The Quantra predicted clinical need for transfusion of platelets (area under the curve 0.71, p = 0.001) but all tests performed poorly at predicting the need for fresh frozen plasma transfusion. We have shown that point-of-care testing using the novel Quantra system provides useful data for guiding transfusion management.
心脏手术期间和之后的凝血功能障碍性出血与发病率和死亡率增加有关。粘弹性检测越来越多地被用于替代实验室检测。我们的目的是比较一种新的即时粘弹性床边检测设备，即 Quantra 系统，与血栓弹性描记法和标准实验室检测的结果。经过伦理批准并获得书面知情同意后，我们前瞻性地招募了接受紧急心脏手术且有出血高风险的成年患者。在体外循环之前、期间和之后比较凝血时间和凝块硬度值。我们前瞻性地招募了 52 名患者，其中 34 名（65%）输注了红细胞。我们通常的纤维蛋白原（1.5 g.l ）、血小板（100,000.μl ）、凝血酶原时间（20 s）、活化部分凝血活酶时间（48 s）和血栓弹性描记法最大振幅的输血阈值（50 mm）与 Quantra 纤维蛋白原凝块硬度 2.0 hPa、血小板凝块硬度 13.5 hPa、凝血时间 159 s、凝血时间 183 s 和凝块硬度 17.0 hPa 相对应。这些 Quantra 阈值对于低血小板（血小板凝块硬度，97.4%）、延长的活化部分凝血活酶时间（凝血时间，92.6%）和减少血栓弹性描记法最大振幅（凝块硬度，93.6%）具有高阴性预测值。Quantra 预测了血小板输血的临床需求（曲线下面积 0.71，p=0.001），但所有检测在预测新鲜冷冻血浆输血需求方面表现不佳。我们已经表明，使用新型 Quantra 系统的即时检测为指导输血管理提供了有用的数据。
