Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
J Heart Lung Transplant. 2021 Jul;40(7):631-641. doi: 10.1016/j.healun.2021.03.020. Epub 2021 Mar 29.
The shortage of blood products has become a worldwide problem, especially during the COVID-19 Pandemic. Here, we investigated whether a point of care (POC) approach to perioperative bleeding and coagulopathy based on rotational thromboelastometry (ROTEM) results could decrease perioperative blood loss and the perioperative consumption of blood products during lung transplantation.
Patients undergoing bilateral lung transplantation were randomized into two groups: In the first group, designated the "non POC" group, the management of perioperative bleeding and coagulopathy was based on the clinical experience of the anesthesiologist; in the second group, designated the "POC" group, the management of perioperative bleeding, and coagulopathy was based on the ROTEM results.
After performing an interim statistical analysis, the project was prematurely terminated as the results were significantly in favor of the POC approach. Data were analyzed for the period January 2018 until June 2020 when 67 patients were recruited into the study. There was significantly decreased perioperative blood loss in the POC group (n = 31 patients) with p = 0.013, decreased perioperative consumption of RBC with p = 0.009, and decreased perioperative consumption of fresh frozen plasma with p < 0.0001 (practically no fresh frozen plasma was used in the POC group) without deteriorating clot formation in secondary and primary hemostasis as compared to the non POC group (n = 36).
POC management of perioperative bleeding and coagulopathy based on ROTEM results is a promising strategy to decrease perioperative blood loss and the consumption of blood products in lung transplantation.
血液制品短缺已成为全球性问题，尤其是在 COVID-19 大流行期间。在这里，我们研究了基于旋转血栓弹性测定法（ROTEM）结果的围手术期出血和凝血障碍的即时检测（POC）方法是否可以减少肺移植期间围手术期的失血和血液制品的消耗。
接受双侧肺移植的患者被随机分为两组：在第一组，即“非 POC”组，围手术期出血和凝血障碍的管理基于麻醉师的临床经验；在第二组，即“POC”组，围手术期出血和凝血障碍的管理基于 ROTEM 结果。
在进行中期统计分析后，由于结果明显有利于 POC 方法，该项目提前终止。数据分析的时间段为 2018 年 1 月至 2020 年 6 月，期间共招募了 67 名患者。与非 POC 组（n=36）相比，POC 组（n=31 名患者）的围手术期出血量明显减少（p=0.013），红细胞的围手术期消耗减少（p=0.009），新鲜冷冻血浆的围手术期消耗减少（p<0.0001，实际上 POC 组没有使用新鲜冷冻血浆），而在二级和一级止血方面的凝血形成没有恶化。
基于 ROTEM 结果的围手术期出血和凝血障碍的 POC 管理是一种有前途的策略，可以减少肺移植期间的围手术期失血和血液制品的消耗。
