Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery.

BACKGROUND: Viscoelastic tests (rotational thromboelastometry, ROTEM® ), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM® implementation.

RESULTS: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p  = .026) during the perioperative period. In the group monitored with ROTEM® , decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p  = .002), fresh frozen plasma (9.8% vs 3.8%, p  = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p  = .599) and activated recombinant factor VII (0.3% vs 0.0%, p  = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p  = .530) and fibrinogen concentrate (0.9% vs 3.5%, p  = .066), tranexamic acid (0.0% vs 0.6%, p  = .370) and protamine administration (0.6% vs 0.9%, p  = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p  = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p  = .037), surgical reexploration (6.0% vs 2.9%, p  = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p  = .026).

CONCLUSIONS: The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.