Rotational Thromboelastometry Rapidly Predicts Thrombocytopenia and Hypofibrinogenemia During Neonatal Cardiopulmonary Bypass

John P. Scott, Robert A. Niebler, Eckehard A.E. Stuth, Debra K. Newman, James S. Tweddell, Rachel S. Bercovitz, D. Woodrow Benson, Regina Cole, Pippa M. Simpson, Ke Yan, Ronald K. Woods

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

BACKGROUND: Thrombocytopenia and hypofibrinogenemia during neonatal cardiopulmonary bypass (CPB) contribute to bleeding and morbidity. Rotational thromboelastometry (ROTEM) is a viscoelastic assay with a rapid turnaround time. Data validating ROTEM during neonatal cardiac surgery remain limited. This study examined perioperative hemostatic trends in neonates treated with standardized platelet and cryoprecipitate transfusion during CPB. We hypothesized that ROTEM would predict thrombocytopenia, hypofibrinogenemia, and the correction thereof.

METHODS: Forty-four neonates undergoing CPB were included in this prospective observational study. Blood samples were obtained at Baseline, On CPB, Post-CPB, and Postoperative. The ROTEM analysis included extrinsically activated (Extem) and fibrinogen-specific (Fibtem) assays. Platelet-specific thromboelastometry (Pltem) values were calculated. Platelet and cryoprecipitate transfusion was initiated prior to termination of CPB.

RESULTS: Platelet count and Extem amplitude decreased significantly On CPB ( P < .0001), increased significantly Post-CPB ( P < .0001), and Postoperative values were not significantly different from Baseline. Extem amplitude at 10 minutes (A10) > 46.5 mm (AUC = 0.941) and Pltem A10 > 37.5 mm [area under curve (AUC) = 0.960] predicted platelet count > 100 × 103/μL, and they highly correlated with platelet count ( R = 0.89 and R = 0.90, respectively). Fibrinogen concentration and Fibtem amplitude decreased significantly On CPB ( P ≤ .0001) and normalized after cryoprecipitate transfusion. Fibtem A10 > 9.5 mm predicted fibrinogen >200 mg/dL (AUC = 0.817), but it correlated less well with fibrinogen concentration ( R = 0.65).

CONCLUSIONS: ROTEM analysis during neonatal cardiac surgery is sensitive and specific for thrombocytopenia and hypofibrinogenemia, identifying deficits within 10 minutes. Platelet and cryoprecipitate transfusion during neonatal CPB normalizes platelet count, fibrinogen level, and ROTEM amplitudes.

Original languageEnglish (US)
Pages (from-to)424-433
Number of pages10
JournalWorld journal for pediatric & congenital heart surgery
Volume9
Issue number4
DOIs
StatePublished - Jul 1 2018

Keywords

  • anesthesia
  • blood coagulation/anticoagulation
  • blood transfusion
  • cardiopulmonary bypass
  • congenital heart surgery
  • fibrinogen
  • hematology
  • neonates
  • platelets

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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    Scott, J. P., Niebler, R. A., Stuth, E. A. E., Newman, D. K., Tweddell, J. S., Bercovitz, R. S., Benson, D. W., Cole, R., Simpson, P. M., Yan, K., & Woods, R. K. (2018). Rotational Thromboelastometry Rapidly Predicts Thrombocytopenia and Hypofibrinogenemia During Neonatal Cardiopulmonary Bypass. World journal for pediatric & congenital heart surgery, 9(4), 424-433. https://doi.org/10.1177/2150135118771318