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

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


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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