Expanding Perfusion Services Through Mobile Point-of-Care Coagulation Monitoring

Abstract

Current trends in cardiac surgery have challenged perfusionists to seek diversification of services. Point-of-care coagulation (POCC) monitoring represents a desirable area of perfusion service expansion. The purpose of the study was to create a series of hemostatic conditions to assess the functionality of POCC monitors to identify specific coagulopathies with identifiable profiles for algorithm development. Fresh (<4 h) bovine blood, anticoagulated with anticoagulant citrate dextrose, was adjusted to a hematocrit of 30.0 ± 2.0%. Hypofibrinogenemia (≤90 mg/dL), thrombocytopenia (≤70,000/ mm3), platelet dysfunction (850 µg/mL of nitroglycerin/mL of blood) and hyperfibrinolysis (0.40 units of urokinase/mL of blood) were created. Five POCC devices were used to evaluate activated clotting time, thrombin time, fibrinogen, platelet function, prothrombin time, activated partial thromboplastin time and thromboelastograph. Results are reported as percentage change from control for each test (abtract table). Each test performed showed specificity and sensitivity for certain coagulopathies, however variability amongst monitors was encountered. In conclusion, the development of a mobile cart incorporating POCC monitors with knowledge of specific coagulopathic conditions may expand perfusion service. Summary of results for induced coagulopathesis. Device Hypofibrinogenemia Thrombocytopenia Platelet Dysfunction Hyperfibrinolysis TEG index −146% p < .05 −84% p < .05 −415% p < .05 −90% p < .05 ACT 23% p < .05 4% p = NS 89% p < .05 27% p < .05 Thrombin time 16% p = NS −4% p = NS 19% p = NS 20% p = NS Fibrinogen –47% p < .05 −19% p = <.05 12% p = NS 5% p = NS Platelet function No result −43% p < NS No result −19% p = NS