Abstract
ObjectivesHypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM).MethodsWe retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group.ResultsOperation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference.ConclusionOur study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.
Highlights
Hypothermic circulatory arrest (HCA) is an effective procedure to perform open anastomosis in bloodless fields while protecting whole organs in aortic surgery [1,2,3]
The objective of this observational study was to analyze coagulopathy in cardiac surgery with or without HCA, using Standard laboratory tests (SLTs) and Rotational thromboelastometry (ROTEM), and to compare the amount of perioperative bleeding and intraoperative transfusion of blood products
There were no significant differences in cardiopulmonary bypass (CPB) time and Aortic cross clamp time between the two groups, but the total operation time and hemostatic time in the HCA group were significantly longer than the non-HCA group
Summary
Hypothermic circulatory arrest (HCA) is an effective procedure to perform open anastomosis in bloodless fields while protecting whole organs in aortic surgery [1,2,3]. It is wellknown that hypothermia may cause coagulopathy, but it is Rotational thromboelastometry (ROTEM) is one of a point-of-care coagulation tests with whole blood viscoelastic. General Thoracic and Cardiovascular Surgery (2020) 68:754–761 hemostatic assays (VHA), which can rapidly assess the detail of coagulation profiles including clot initiation, clot formation, clot stability and fibrinolysis [7]. There have been few studies analyzing coagulopathy associated with HCA by using ROTEM [8] The objective of this observational study was to analyze coagulopathy in cardiac surgery with or without HCA, using SLTs and ROTEM, and to compare the amount of perioperative bleeding and intraoperative transfusion of blood products
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