Abstract Number: PB0281
Meeting: ISTH 2020 Congress
Background: ROTEM has been proven to be useful for bleeding prediction in adult patients undergoing cardiac surgeries, especially in cases with cardiopulmonary bypass (CPB). However, evidence is still lacking for efficacy of ROTEM assessment in pediatric cardiac surgery.
Aims: The aim of this study was to investigate the correlation between perioperative ROTEM parameters and amount of postoperative blood loss in children undergoing heart surgeries.
Methods: We performed a case-series, prospective study on pediatric patients undergoing heart surgeries with CPB at Cho Ray Hospital from February to July 2019. We monitored the patients from the start of operations until 12 hours postoperatively. Activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen level and ROTEM assays (INTEM, EXTEM, FibTEM, HepTEM and APTEM) were performed simultaneously at the end of CPB. Evaluation of postoperative blood loss was determined by the total amount of blood in the chest drainage system. A blood loss of more than 10 ml/kg was considered clinically significant.
Results: In total, 40 patients were admitted to the study. 12 patients had clinically significant bleeding. ROTEM parameters including INTEM CFT, INTEM ALPHA, EXTEM CT, EXTEM CFT, EXTEM ALPHA, FIBTEM CT, FIBTEM A5, FIBTEM A20, FIBTEM A30, FIBTEM MCF, APTEM CT, and APTEM ALPHA were strongly correlated (|r| >0.5) with blood loss 12 hours after surgery, while APTT (R), platelet count were only moderately correlated (0.3 ≤ |r| ≤ 0.5). Several ROTEM parameters showed good predicting value for postoperative bleeding, including INTEM CT (sensitivity 75.00%, specificity 71.43%), INTEM CFT (sensitivity 90.90%, specificity 46.40%), EXTEM CT (sensitivity 54.50%, specificity 92.86%), EXTEM CFT (sensitivity 90.90%, specificity 57.14%), FIBTEM CT (sensitivity 75.00%, specificity 92.80%), APTEM CT(sensitivity 75.00%, specificity 58.57%).
Conclusions: ROTEM may be useful for predicting postoperative hemorrhage in pediatric cardiac surgery. Future studies with larger samples are warranted in order to develop ROTEM-based transfusion guidelines in pediatric cardiac surgery.
To cite this abstract in AMA style:Truong-Pham D, Nguyen T, Beaupha S, Tran T, Lai T, Nguyen T, Le-Thanh P, Pham-Thi L-, Le-Thanh V, Sa P, Nguyen D, Nguyen T-. ROTEM Parameters As Bleeding Predictors In Pediatric Cardiac Surgery With Cardiopulmonary Bypass [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/rotem-parameters-as-bleeding-predictors-in-pediatric-cardiac-surgery-with-cardiopulmonary-bypass/. Accessed September 29, 2023.
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