Thromboelastometry and a hemostasis management system are most beneficial for guiding hemostatic therapy in cardiac surg
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ORIGINAL ARTICLE
Thromboelastometry and a hemostasis management system are most beneficial for guiding hemostatic therapy in cardiac surgery patients with a EuroSCORE II of ≥1.83%: a randomized controlled two‑step trial Mitsuharu Kodaka1 · Junko Ichikawa1 · Kazuyoshi Ando1 · Makiko Komori1 Received: 24 January 2020 / Accepted: 30 May 2020 © Japanese Society of Anesthesiologists 2020
Abstract Purpose We evaluated the efficacy of hemostatic therapy based on point-of-care (POC) testing in patients undergoing cardiac surgery. Methods This was a single-institution, prospective, randomized, double-blinded study. In step 1, 90 patients scheduled for elective cardiac surgery underwent complete blood count and fibrinogen measurements at baseline, after cardiopulmonary bypass (CPB) initiation (CPB start), just after CPB end, and in the intensive care unit (ICU). In step 2, 72 patients scheduled for elective cardiac surgery underwent conventional laboratory coagulation tests (control group) or POC coagulation tests (POC group). Transfusions were prepared using the fibrinogen and platelet values at mainly “CPB start” for the control group, and using the ROTEM values at mainly “CPB end” for the POC group. Consequently, the step 2 patients were divided into high- and low-risk subgroups based on the EuroSCORE II by logistic regression analysis; transfusion data and bleeding volumes were compared between the control and POC groups within the high- and low-risk subgroups. Results In step 1, all blood components were significantly decreased at CPB start compared with baseline, and platelet and fibrinogen levels remained almost constant from CPB start to end. In step 2, the transfusion rates and perioperative bleeding volumes did not significantly differ between the control and POC groups. Subgroup analysis suggested that only the highrisk subgroup significantly differed regarding perioperative red blood cell transfusion and total bleeding volume in the ICU. Conclusions POC testing is beneficial for cardiac surgery patients with a EuroSCORE II of ≥1.83%. Keywords Thromboelastometry · Hepcon HMS plus · Cardiovascular surgery
Introduction Several retrospective studies have shown that point-of-care (POC) coagulation tests such as rotation thromboelastometry (ROTEM™) [1–4], thromboelastography [5–7], and the use of a hemostasis management system (Hepcon HMS Plus™) [8] reduce the requirements for hemostatic products and shorten the hospital stay. However, few prospective studies [9, 10] or meta-analyses [11] have provided evidence that POC coagulation tests have these effects, particularly in low-risk cases. In comparison with POC coagulation tests, * Mitsuharu Kodaka [email protected]‑net.ne.jp 1
Department of Anesthesiology and Intensive Care, Tokyo Women’s Medical University Medical Center East, Arakawa‑ku, Tokyo 116‑8567, Japan
the main drawback of conventional laboratory coagulation testing is the time taken to obtain results, which is generally 30–60 min with transportation and centrifugation of blood samples. Moreover,
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