Abstract
Introduction. Rotational thromboelastometry (ROTEM) in monitoring coagulation in children undergoing cardiac surgery has been studied with promising results. Since the data about ROTEM in infants and neonates undergoing cardiac surgery are scarce, the aim of our study was to asses ROTEM abnormalities in this patient group.Methods. Infants and neonates undergoing cardiac surgery on cardiopulmonary bypass were included in this prospective, observational study conducted in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU) between May 2011 and January 2012. ROTEM analysis, together with determination of platelet count, international normalized ratio of prothrombin time (INR), activated partial thromboplastin time (PTT), and fibrinogen concentration, was done in all neonates and infants before surgery (t1), after admission to ICU (t2) and 24 hours after surgery (t3).Results. Twenty infants and neonates were operated on during the time of the study. ROTEM abnormalities seen after sur-gery (t2) were: thrombocytopenia 14, hypofibrinogenemia 1, mixed hypofibrinogenemia and coagulation factor deficiency 1, and mixed thrombocytopenia with mild hyperfibrinolysis 1. Three patients were found to have normal ROTEM results. The median values of all except one of the ROTEM tests, as well as platelet count, INR, PTT, and fibrinogen concentration, showed significant prolongation or deterioration after admission to ICU and these deteriorations persisted in several para-meters for 24 hours.Conclusions. In our neonates and infants, cardiac surgery on cardiopulmonary bypass predominantly affects platelets, although most of the ROTEM parameters deteriorated after admission to ICU.
Highlights
Rotational thromboelastometry (ROTEM) in monitoring coagulation in children undergoing cardiac surgery has been studied with promising results
Cardiac surgery on cardiopulmonary bypass can affect different aspects of coagulation. (15-17) most of the ROTEM parameters showed significant deterioration following surgery, thrombocytopenia was the predominant ROTEM abnormality seen in our group of neonates and infants
Straub et al found in 10 infants undergoing cardiac surgery on cardiopulmonary bypass prolongation of clotting time (CT) in INTEM and HEPTEM and a decrease in INTEM, HEPTEM, EXTEM and FIBTEM amplitude which represented a measure for clot firmness and is similar to our maximum clot firmness (MCF). (7) The authors concluded that these changes reflected the defect in plasmatic coagulation together with platelet damage
Summary
Rotational thromboelastometry (ROTEM) in monitoring coagulation in children undergoing cardiac surgery has been studied with promising results. Since the data about ROTEM in infants and neonates undergoing cardiac surgery are scarce, the aim of our study was to asses ROTEM abnormalities in this patient group. ROTEM analysis, together with determination of platelet count, international normalized ratio of prothrombin time (INR), activated partial thromboplastin time (PTT), and fibrinogen concentration, was done in all neonates and infants before surgery (t1), after admission to ICU (t2) and 24 hours after surgery (t3). In our neonates and infants, cardiac surgery on cardiopulmonary bypass predominantly affects platelets, most of the ROTEM parameters deteriorated after admission to ICU. Rotational Thromboelastometry (ROTEM) graphically represents the fibrin polymerization process in a thromboelastogram and provides a complete evaluation of the process of clot initiation, formation, and stability. (1) The original one-trace ROTEM was recently upgraded with the addition of new different coagulation-inducing agents and platelet-inhibiting agents, which allow detection of specific coagulation defects like hypofibrinogenemia, factor deficiency, thrombocytopenia, heparin influence and hyperfibrinolysis. (2,3) The causes of bleeding in patients undergoing cardiac surgery on cardiopulmonary bypass are multifactorial, and involve hemodilution, anticoagulation (heparin), activation of coagulation and fibrinolytic systems and impairment of platelet function. (4) ROTEM provides a tool to asses some of these changes and it is a faster method than standard laboratory tests of coagulation. (5,6) First results with ROTEM can be obtained within 10-30 minutes. (1,7) ROTEM has already been successfully used as a point of care test in adult cardiac surgery (2,8,9) and there is growing evidence of its usefulness in paediatric cardiac surgery. (4,7,10-12) Since the coagulation system in infants and neonates has some unique characteristics (4,13,14) and the data about thromboelastometry in infants and neonates after cardiac surgery are scarce, we decided to asses ROTEM abnormalities in neonates and infants undergoing cardiac surgery
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