Monaco Fabrizio, Nardelli Pasquale, Denaro Giuseppe, De Luca Monica, Franco Annalisa, Bertoglio Luca, Castiglioni Alessandro, Zangrillo Alberto
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Clin Anesth. 2020 Nov;66:109910. doi: 10.1016/j.jclinane.2020.109910. Epub 2020 May 30.
To assess the effect of a rotational thromboelastometry (ROTEM)-enhanced transfusion algorithm with hemostatic agents on allogenic blood transfusion in patients undergoing frozen elephant trunk (FET) surgery.
Retrospective observational study conducted in a tertiary-care center.
A tertiary care referral center for cardiac surgery.
All patients undergoing elective FET were included in the study.
Until 2016, a protocol based on estimated blood losses and conventional coagulation tests was used. After, a ROTEM-enhanced transfusion protocol was adopted.
The transfusion rate of each blood component was observed and reported.
Retrospective, observational study.
Out of 40 consecutive patients, 19 underwent FET surgery with a conventional transfusion approach and 21 with a ROTEM-enhanced transfusion strategy. Considering the overall transfusion rate, the administration of fresh frozen plasma and platelets was significantly lower in the ROTEM compared to conventional group (1000 [0-2500] vs 0 [0-875] ml, p = 0.015 and 1 [1, 2] vs 0 [0-1], p = 0.016, respectively). ROTEM algorithm allowed to decrease the number of patients who required plasma and platelets transfusion of 31%. Furthermore, a 40% reduction in overall allogenic blood products was observed. Number of red blood cells administered, percentage of patients transfused with red blood cells, blood losses, reoperation for bleeding and mortality did not significantly differ between the two groups. At the multiple linear regression analysis only ROTEM algorithm was associated with a significant decrease in the number of plasma and platelets units administered intraoperatively, at 24 h, at the ICU discharge and overall. ROTEM algorithm allowed to save 1435 ml of plasma, 0.91 unit of platelets and overall transfusion cost of the 21% per patient.
A ROTEM-enhanced transfusion strategy halved intraoperative transfusion in the setting of FET. Further studies are needed to confirm the magnitude of our findings on clinically relevant endpoints.
评估采用旋转血栓弹力图（ROTEM）增强输血方案并联合止血药物对接受象鼻支架植入术（FET）患者异体输血的影响。
在一家三级医疗中心进行的回顾性观察研究。
一家心脏外科三级医疗转诊中心。
所有接受择期FET手术的患者均纳入本研究。
直到2016年，采用基于估计失血量和传统凝血试验的方案。之后，采用ROTEM增强输血方案。
观察并报告每种血液成分的输血率。
回顾性观察研究。
在连续40例患者中，19例采用传统输血方法接受FET手术，21例采用ROTEM增强输血策略。考虑总体输血率，ROTEM组新鲜冰冻血浆和血小板的输注量显著低于传统组（分别为1000 [0 - 2500] 毫升 vs 0 [0 - 875] 毫升，p = 0.015；以及1 [1, 2] 单位 vs 0 [0 - 1] 单位，p = 0.016）。ROTEM方案使需要输注血浆和血小板的患者数量减少了31%。此外，观察到异体血液制品总量减少了40%。两组之间输注红细胞的数量、输注红细胞的患者百分比、失血量、因出血进行的再次手术以及死亡率并无显著差异。在多元线性回归分析中，只有ROTEM方案与术中、术后24小时、重症监护病房出院时及总体输注的血浆和血小板单位数量显著减少相关。ROTEM方案可为每位患者节省1435毫升血浆、0.91单位血小板以及21%的总体输血费用。
在FET手术中，ROTEM增强输血策略使术中输血量减半。需要进一步研究以证实我们在临床相关终点方面研究结果的影响程度。
