Karrar Senned, Filius Anika, Langmuur Sanne Jj, Mahtab Edris Af, Hoek Rogier, Hoeks Sanne E, Hellemons Merel E, Ter Horst Maarten
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
JHLT Open. 2024 Jan 17;3:100055. doi: 10.1016/j.jhlto.2024.100055. eCollection 2024 Feb.
Blood transfusion is often necessary during and after lung transplantation surgery. Point-of-care guided bleeding strategies, such as rotational thromboelastometry (ROTEM), can reduce blood transfusion in cardiovascular surgery. This study aimed to assess the effect of ROTEM-guided bleeding management on the need for allogenic blood transfusion, prohemostatic medication, and clinical outcomes in lung transplantation patients.
This single-center retrospective cohort study compared patients receiving bilateral lung transplantation between 2010-2014 and 2017-2020. The first cohort was treated with a clinically guided bleeding strategy and the second cohort with a ROTEM-guided bleeding strategy. Multivariable regression analyses were performed to determine the effects on primary outcomes.
A total of 167 (66 clinically guided vs 101 ROTEM-guided) patients were included for analysis. Baseline, intraoperative, and postoperative characteristics were mostly similar, but differed regarding the number of patients with cystic fibrosis, use of cardiopulmonary bypass, and surgical technique. The ROTEM-guided group received significantly less median red blood cells (7 [3; 13] vs 4 [1; 9] units, < 0.01), platelet concentrate (2 [0; 3] vs 0 [0; 2] units, = 0.01), and plasma volume (2,310 [1,320; 3,960] vs 800 [0; 1,600] ml, < 0.01). In multivariable regression analysis, implementation of the ROTEM strategy only remained significantly associated with a decreased use of plasma volume. Cardiopulmonary bypass significantly increased allogenic blood transfusion needs. Moreover, more prothrombin complex concentrate, fibrinogen concentrate, and less tranexamic acid were used in the ROTEM-guided group.
ROTEM-guided bleeding management reduces plasma transfusion in bilateral lung transplant surgery and cardiopulmonary bypass seems to increase transfusion needs.
肺移植手术期间及术后常需输血。床旁指导的出血管理策略，如旋转血栓弹力图（ROTEM），可减少心血管手术中的输血。本研究旨在评估ROTEM指导的出血管理对肺移植患者异体输血需求、促凝血药物使用及临床结局的影响。
这项单中心回顾性队列研究比较了2010 - 2014年和2017 - 2020年间接受双侧肺移植的患者。第一组采用临床指导的出血策略治疗，第二组采用ROTEM指导的出血策略治疗。进行多变量回归分析以确定对主要结局的影响。
共纳入167例患者（66例临床指导组 vs 101例ROTEM指导组）进行分析。基线、术中及术后特征大多相似，但在囊性纤维化患者数量、体外循环使用情况及手术技术方面存在差异。ROTEM指导组接受的红细胞中位数显著更少（7 [3; 13]单位 vs 4 [1; 9]单位，< 0.01）、血小板浓缩物（2 [0; 3]单位 vs 0 [0; 2]单位，= 0.01）及血浆量（2310 [1320; 3960] ml vs 800 [0; 1600] ml，< 0.01）。在多变量回归分析中，ROTEM策略的实施仅与血浆量使用减少显著相关。体外循环显著增加了异体输血需求。此外，ROTEM指导组使用了更多的凝血酶原复合物浓缩物、纤维蛋白原浓缩物，而氨甲环酸使用较少。
ROTEM指导的出血管理可减少双侧肺移植手术中的血浆输血，体外循环似乎会增加输血需求。
