Benefit of Rotational Thromboelastometry (ROTEM) in Open Cardiac Surgery
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Published:
Sep 25, 2018
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Abstract
Cardiac surgery involves a large of blood loss. Eighty percent of the patients undergoing open cardiac surgery receive blood component transfusions. Nowadays, rotational thromboelastometry (ROTEM) is used to evaluate disorders of blood clotting factors and the fibrinolytic process. This diagnostic test can be done in the operating room perioperatively and the ROTEM results are rapidly available. The anesthesiologist can use the ROTEM monitoring assays to guide blood transfusion during cardiac surgery. This review is aimed to summarize the previous studies. Benefits of using ROTEM help anesthesiologists comprehend and be able to deal with their patients.
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Review articles
References
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2. Gorlinger K, Bergmann L, Dirkmann D. Coagulation management in patients undergoing mechanical circulatory support. Best Pract Res Clin Anaesthesiol 2012;26(2):179-98.
3. Despotis GJ, Joist JH, Goodnough LT. Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes. Clin Chem 1997;43(9):1684-96.
4. Ogawa S, Szlam F, Chen EP, et al. A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution-induced coagulation changes after cardiac surgery. Transfusion 2012;52(1):14-22.
5. Dirkmann D, Gorlinger K, Dusse F, Kottenberg E, Peters J. Early thromboelastometric variables reliably predict maximum clot firmness in patients undergoing cardiac surgery: a step towards earlier decision making. Acta Anaesthesiol Scand 2013;57(5):594-603.
6. Straub A, Schiebold D, Wendel HP, et al. Using reagent-supported thromboelastometry (ROTEM) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest. Eur J Cardiothorac Surg 2008;34(3):641-7.
7. Tanaka KA, Bolliger D, Vadlamudi R, Nimmo A. Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. J Cardiothorac Vasc Anesth 2012;26(6):1083-93.
8. Girdauskas E, Kempfert J, Kuntze T, et al. Thromboelasto¬metrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. J Thorac Cardiovasc Surg 2010;140(5):1117-24 e2.
9. Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev 2012;26(1):1-13.
10. Tem Innovations GmbH.How it Works: ROTEM®Analysis Portable Network Graphic. Munich, Germany: Tem Innovations GmbH; 2013[Internet]. [cited 2015 Nov 1]. Available from: http://www.rotem.de/site/index.php?option= com_content&view=article&id=2&Itemid=8&lang=en.
11. Lang T, von Depka M. Possibilities and limitations of thrombelastometry/-graphy. Hamostaseologie 2006; 26(3 Suppl 1):S20-9.
12. Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94(5):773-81
13. Goodnough LT, Soegiarso RW, Birkmeyer JD, Welch HG. Economic impact of inappropriate blood transfusions in coronary artery bypass graft surgery. Am J Med 1993;94(5): 509-14.
14. Anderson L, Quasim I, Soutar R, Steven M, Macfie A, Korte W. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit. Transfus Med 2006;16(1):31-9.
15. Gorlinger K, Dirkmann D, Hanke AA, et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 2011;115(6):1179-91.
16. Paniagua P, Koller T, Requena T, Gil JM, Campos JM, Galan J. Randomized controled trial to evaluate postoperative coagulation management with bedside thromboelastometry (Rotem) compared with a transfusion protocol based on laboratory measurements in bleeding patients after cardiac surgery: Preliminary data. Eur J Anaesthesiol 2011;28:94.
17. Romlin BS, Wahlander H, Berggren H, et al. Intraoperative thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery. Anesth Analg 2011;112(1):30-6.
18. Weber CF, Gorlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012;117(3):531-47.
2. Gorlinger K, Bergmann L, Dirkmann D. Coagulation management in patients undergoing mechanical circulatory support. Best Pract Res Clin Anaesthesiol 2012;26(2):179-98.
3. Despotis GJ, Joist JH, Goodnough LT. Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes. Clin Chem 1997;43(9):1684-96.
4. Ogawa S, Szlam F, Chen EP, et al. A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution-induced coagulation changes after cardiac surgery. Transfusion 2012;52(1):14-22.
5. Dirkmann D, Gorlinger K, Dusse F, Kottenberg E, Peters J. Early thromboelastometric variables reliably predict maximum clot firmness in patients undergoing cardiac surgery: a step towards earlier decision making. Acta Anaesthesiol Scand 2013;57(5):594-603.
6. Straub A, Schiebold D, Wendel HP, et al. Using reagent-supported thromboelastometry (ROTEM) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest. Eur J Cardiothorac Surg 2008;34(3):641-7.
7. Tanaka KA, Bolliger D, Vadlamudi R, Nimmo A. Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. J Cardiothorac Vasc Anesth 2012;26(6):1083-93.
8. Girdauskas E, Kempfert J, Kuntze T, et al. Thromboelasto¬metrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. J Thorac Cardiovasc Surg 2010;140(5):1117-24 e2.
9. Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev 2012;26(1):1-13.
10. Tem Innovations GmbH.How it Works: ROTEM®Analysis Portable Network Graphic. Munich, Germany: Tem Innovations GmbH; 2013[Internet]. [cited 2015 Nov 1]. Available from: http://www.rotem.de/site/index.php?option= com_content&view=article&id=2&Itemid=8&lang=en.
11. Lang T, von Depka M. Possibilities and limitations of thrombelastometry/-graphy. Hamostaseologie 2006; 26(3 Suppl 1):S20-9.
12. Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94(5):773-81
13. Goodnough LT, Soegiarso RW, Birkmeyer JD, Welch HG. Economic impact of inappropriate blood transfusions in coronary artery bypass graft surgery. Am J Med 1993;94(5): 509-14.
14. Anderson L, Quasim I, Soutar R, Steven M, Macfie A, Korte W. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit. Transfus Med 2006;16(1):31-9.
15. Gorlinger K, Dirkmann D, Hanke AA, et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 2011;115(6):1179-91.
16. Paniagua P, Koller T, Requena T, Gil JM, Campos JM, Galan J. Randomized controled trial to evaluate postoperative coagulation management with bedside thromboelastometry (Rotem) compared with a transfusion protocol based on laboratory measurements in bleeding patients after cardiac surgery: Preliminary data. Eur J Anaesthesiol 2011;28:94.
17. Romlin BS, Wahlander H, Berggren H, et al. Intraoperative thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery. Anesth Analg 2011;112(1):30-6.
18. Weber CF, Gorlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012;117(3):531-47.