Rotational Thromboelastometry-Guided versus Conventional Transfusion Strategies in Adult Cardiac Surgery with Cardiopulmonary Bypass: Impact on Blood Product Utilization
DOI:
https://doi.org/10.64149/Keywords:
Rotational thromboelastometry, ROTEM, cardiac surgery, cardiopulmonary bypass, transfusionAbstract
Background: Excessive bleeding and coagulopathy after cardiac surgery with cardiopulmonary bypass (CPB) remain major challenges, increasing transfusion requirements and postoperative complications. Conventional laboratory tests may delay diagnosis and targeted treatment, whereas rotational thromboelastometry (ROTEM) provides rapid, point-of-care assessment of hemostatic function to guide targeted correction of coagulation abnormalities.
Aim: To compare efficacy and short-term safety of ROTEM-guided transfusion versus conventional transfusion strategies in patients undergoing elective cardiac surgery with cardiopulmonary bypass.
Methods: This prospective randomized study included 80 adults undergoing elective cardiac surgery under CPB at the National Heart Institute, GOTHI. Patients were assigned to ROTEM-guided or conventional transfusion groups and underwent CABG, valve replacement, or combined procedures. Cardiovascular risk factors, preoperative antithrombotic therapy, 30-day cardiovascular complications, baseline echocardiographic parameters, and post-transfusion blood pressure were assessed.
Results: The ROTEM-guided group received fewer packed red blood cell (median 2 vs. 4; P = 0.001), fresh frozen plasma (median 2 vs. 3; P = 0.001), and platelet units (median 1 vs. 2; P = 0.020), with similar cryoprecipitate use (P = 0.182). Twenty-four-hour chest-drain output was also lower (528.8 ± 141.4 vs. 701.9 ± 174.5 mL; P = 0.001). No significant differences were observed in re-exploration, ICU or hospital stay, 30-day mortality, MACE, or other cardiovascular complications. Baseline echocardiographic parameters and post-transfusion blood pressures were also comparable.
Conclusion: In adults undergoing elective cardiac surgery with CPB, ROTEM-guided management reduced blood product use and postoperative chest drain output, without significant differences in measured short-term safety outcomes. However, the sample size was insufficient to establish safety equivalence. Post-protamine ROTEM values were obtained before treatment and should not be interpreted as treatment-related improvement.
