Titre
Validation of rotational thromboelastometry during cardiopulmonary bypass: A prospective, observational in-vivo study.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Gronchi, F.
Auteure/Auteur
Perret, A.
Auteure/Auteur
Ferrari, E.
Auteure/Auteur
Marcucci, C.M.
Auteure/Auteur
Flèche, J.
Auteure/Auteur
Crosset, M.
Auteure/Auteur
Schoettker, P.
Auteure/Auteur
Marcucci, C.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1365-2346
Statut éditorial
Publié
Date de publication
2014
Volume
31
Numéro
2
Première page
68
Dernière page/numéro d’article
75
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
BACKGROUND: Rotational thromboelastometry (ROTEM) is a whole blood point-of-test used to assess the patient's coagulation status. Three of the available ROTEM tests are EXTEM, INTEM and HEPTEM. In the latter, heparinase added to the INTEM reagent inactivates heparin to reveal residual heparin effect. Performing ROTEM analysis during cardiopulmonary bypass (CPB) might allow the anaesthesiologist to anticipate the need for blood products.
OBJECTIVE: The goal of this study was to validate ROTEM analysis in the presence of very high heparin concentrations during CPB.
DESIGN: Prospective, observational trial.
SETTING: Single University Hospital.
PARTICIPANTS: Twenty patients undergoing coronary artery bypass grafting.
MAIN OUTCOME MEASURE: ROTEM analysis was performed before heparin administration (T0), 10 min after heparin (T1), at the end of CPB (T2) and 10 min after protamine (T3). The following tests were performed: EXTEM, INTEM, and HEPTEM. Heparin concentrations were measured at T1 and at the end of bypass (T2).
RESULTS: At T1, EXTEM differed from baseline for coagulation time: +26.7 s (18.4 to 34.9, P < 0.0001), α: -3° (1.0 to 5.4, P = 0.006) and A10: -4.4 mm (2.3 to 6.5, P = 0.0004). INTEM at T0 was different from HEPTEM at T1 for coagulation time: + 47 s (34.3 to 59.6, P >0.0001), A10: -2.3 mm (0.5 to 4.0, P = 0.01) and α -2° (1.0 to 3.0; P = 0.0007). At T2, all parameters in EXTEM and HEPTEM related to fibrin-platelet interaction deteriorated significantly compared to T1. At T3, EXTEM and INTEM were comparable to EXTEM and HEPTEM at T2.
CONCLUSION: HEPTEM and EXTEM measurements are valid in the presence of very high heparin concentrations and can be performed before protamine administration in patients undergoing cardiac surgery with CPB.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01455454.
OBJECTIVE: The goal of this study was to validate ROTEM analysis in the presence of very high heparin concentrations during CPB.
DESIGN: Prospective, observational trial.
SETTING: Single University Hospital.
PARTICIPANTS: Twenty patients undergoing coronary artery bypass grafting.
MAIN OUTCOME MEASURE: ROTEM analysis was performed before heparin administration (T0), 10 min after heparin (T1), at the end of CPB (T2) and 10 min after protamine (T3). The following tests were performed: EXTEM, INTEM, and HEPTEM. Heparin concentrations were measured at T1 and at the end of bypass (T2).
RESULTS: At T1, EXTEM differed from baseline for coagulation time: +26.7 s (18.4 to 34.9, P < 0.0001), α: -3° (1.0 to 5.4, P = 0.006) and A10: -4.4 mm (2.3 to 6.5, P = 0.0004). INTEM at T0 was different from HEPTEM at T1 for coagulation time: + 47 s (34.3 to 59.6, P >0.0001), A10: -2.3 mm (0.5 to 4.0, P = 0.01) and α -2° (1.0 to 3.0; P = 0.0007). At T2, all parameters in EXTEM and HEPTEM related to fibrin-platelet interaction deteriorated significantly compared to T1. At T3, EXTEM and INTEM were comparable to EXTEM and HEPTEM at T2.
CONCLUSION: HEPTEM and EXTEM measurements are valid in the presence of very high heparin concentrations and can be performed before protamine administration in patients undergoing cardiac surgery with CPB.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01455454.
PID Serval
serval:BIB_9C7F59916FD9
PMID
Date de création
2014-02-07T17:16:16.883Z
Date de création dans IRIS
2025-05-20T21:05:01Z