EVALUATION OF THE IMPLEMENTATION OF ROTATIONAL THROMBOELASTOMETRY GUIDED COAGULATION MANAGEMENT IN ADULT CARDIAC SURGERY

Abstract

<h3>Objective</h3> To evaluate changes in the administration of blood products and hemostatic drugs following the implementation of rotational thronboelastometry (ROTEM) in cardiac surgery in adult patients. To analyze changes in the rate of reintervention and perioperative complications. Economic analysis on the consumption of blood products, hemostatic drugs and ROTEM cartridges. <h3>Design and method</h3> Single-center retrospective cohort study. Exclusion criteria: interventions without cardiopulmonary bypass (CPB), emergent surgery, circulatory assist devices, heart transplant, ascending aortic dissection, Jehovah's Witness patients, congenital hemostasis disorders, and severe liver disease. In group 1 (before ROTEM), blood products and hemostatic drugs were administered empirically at the anesthesiologist's discretion. Activated clotting time, point-of-care prothrombin time testing, standard laboratory tests and clinical variables were used to guide therapeutic management. In group 2 (after ROTEM), blood products and hemostatic drugs were administered according to the Gorlinger algorithm modified. Variables preoperative period: age, sex, weight, height, BMI, BSA, hemoglobin level, number of platelets, creatinine, glomerular filtration rate, previous cardiac surgery. Variables intraoperative period: type of surgery, duration of CPB, administration of packed red blood cells (PRBC), platelet concentrates (PC), fresh frozen plasma (FFP), fibrinogen concentrate (FC), prothrombin complex concentrate (PCC) and rFVIIa. Variables postoperative period: reintervention (first 24h), mechanical ventilation >24h, acute lung injury (ALI), infection, thrombotic events, death, ICU and hospital length of stay. <h3>Results</h3> 759 patients were included, 438 in group 1 and 321 in group 2. There were no significant differences in age, sex, weight, height, BMI, BSA, preoperative anemia, thrombocytopenia, renal failure, previous cardiac surgery, type of surgey or interventions with CPB time >120 minutes. A significant reduction was observed in the number of patients who received PRBC (19% vs 29.2%; p = 0.001), FFP (1.6% vs 7.5%; p < 0.001), FC (23.4% vs 30.6%; p = 0.028) and rFVIIa (0.3% vs 2.7%; p = 0.011). A significant decrease was observed in the total quantity of PRBC, PC, FFP, FC and rFVIIa administered per patient. A significant reduction was observed in the incidence of postoperative infection (5.3% vs 10.3%; p = 0.013), ICU stay (median of 3 d vs 4 d; p < 0.001) and hospital stay (median of 8 d vs 11 d; p <0.001). There were no significant differences in the need for prolonged mechanical ventilation, surgical revision, incidence of ALI, thrombotic events or death. The economic analysis showed a total cost of 403,394.99 euros for group 1 and 203,292.97 euros for group 2. The average cost per patient was 921.00 euros in group 1 and 633.31 euros in group 2 (reduction of 30%). <h3>Conclusions</h3> Thromboelastometry reduces the administration of blood products and hemostatic drugs, in addition to lowering costs. The decreases in the incidence of infections and ICU and hospital stays cannot be solely attributed to the ROTEM technique as there are other factors that may have contributed.