Effect of Temperature Changing during Cardiopulmonary  Bypass on Coagulation in Patient Undergoing Coronary  Bypass Graft: an Observational Pilot Study

Panthila Rujirojindakul; Napipada  Thanyajaroenkanka; Edward  McNeil; Wirat  Wasinwong; Pairaya  Rujirojindakul; Voravit  Chittithavorn; Pongsanee  Duenpakdee; Yupin  Apisittiwong

Authors

Panthila Rujirojindakul Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Napipada Thanyajaroenkanka Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Edward McNeil Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Wirat Wasinwong Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Pairaya Rujirojindakul Blood Bank and Transfusion Medicine, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Voravit Chittithavorn Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Pongsanee Duenpakdee Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Yupin Apisittiwong Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Keywords:

cardiopulmonary bypass, coagulation, coronary artery bypass graft, rotational thromboelastometry

Abstract

Background: Hypothermia and cardiopulmonary bypass (CPB) are the main factors that disturbed the coagulation process during cardiac surgery. Rotational thromboelastometry (ROTEM) can be used to monitor the coagulation changing from moderate hypothermia during coronary artery bypass graft (CABG) surgery. Objective: The purpose of this study was to assess the effect of induced hypothermia on standard coagulation test and ROTEM to detect hemostasis changes in elective CABG. Method: An observational pilot study was conducted on five patients. Blood samples were collected from the arterial line at six different time points: at baseline (after arterial cannulation), 5 minutes after heparinization, 10 minutes after CPB, when the rectal temperature reaching 32ºC, and 10 minutes after protamine administration. The patient’s serum was analyzed in ROTEM including INTEM, EXTEM, HEPTEM, FIBTEM, and standard coagulation test. Results: Our data showed prolongation of the coagulation time, clot formation time, and attenuation in alpha angle, A10 and maximum clot firmness (MCF) by INTEM, EXTEM, HEPTEM, and FIBTEM from ROTEM during hypothermia during cardiopulmonary bypass. The standard coagulation test showed a decrease in platelet counts. However, the decrease of platelet counts did not lead to a decrease in the hemostatic function of platelets, as assessed by MCF. Conclusion: No statistically significant differences between ROTEM and standard coagulation test from the effect of temperature change to moderate hypothermia (at 32ºC) during CPB in CABG surgical patient.

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