Thromboelastography-guided Intraoperative Platelet Transfusion in Pediatric Heart Surgery

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-09-12 DOI:10.1016/j.athoracsur.2024.09.003

Sirisha Emani PhD , Reece Donahue BS , Aminah Callender BS , Merhawi Ghebremichael BS , Meena Nathan MD, MPH , Juan C. Ibla MD, MS , Sitaram Emani MD

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引用次数: 0

Abstract

Background

Postoperative bleeding is associated with significant resource use and is an important contributor to other major adverse events in pediatric patients undergoing complex cardiac surgical procedures. Thromboelastography (TEG; TEG 6S, Haemonetics) can guide perioperative blood product transfusions to reduce the risk of postoperative bleeding. This study validated the use of a previously developed TEG 6S maximum amplitude (TEG-MA)–based platelet transfusion calculator used during cardiac surgical procedures to minimize the risk of postoperative bleeding.

Methods

In this single-center retrospective study of pediatric patients (aged ≤18 years) who underwent cardiac surgical procedures requiring cardiopulmonary bypass at Boston Children’s Hospital (Boston, MA) (N = 1000), the volume of platelet transfusion administered at surgical team discretion was compared with the platelet calculator–recommended platelet transfusion volume by using linear regression analysis. Associations between the adequacy of perioperative platelet transfusion and postoperative bleeding or thrombotic complications within the first 24 hours postoperatively (bleeding) and until hospital discharge (thrombosis) were evaluated by logistic regression analysis.

Results

Lower TEG-MA (≤45 mm) measurements after transfusion were associated with a higher risk for postoperative bleeding (odds ratio, 4.4; 95% CI, 2.6-7.4; P < .01 [significant P value <.05]). The platelet transfusion calculator–recommended platelet transfusion volume (on the basis of TEG-MA measured at the time of rewarming) demonstrated moderate correlation with the measured TEG-MA value after platelet transfusion (Pearson r = 0.7). Intraoperative volumes of platelet transfusion that failed to increase a postoperative TEG-MA of at least 45 mm significantly increased the risk for postoperative bleeding in the first 24 hours after surgical procedures (odds ratio, 3.2; 95% CI, 1.9-5.4; P < .01 [significant P value <.05]). The posttransfusion TEG-MA was not independently associated with thrombosis.

Conclusions

Customizing perioperative platelet transfusion therapy by using quantitative diagnostic tests can help reduce postoperative bleeding complications.

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血栓弹性成像--引导小儿心脏手术术中血小板输注。

背景：术后出血与大量资源的使用有关，也是导致接受复杂心脏外科手术的儿科患者发生其他重大不良事件的重要原因。血栓弹性成像（TEG®6S）可指导围手术期输血，降低术后出血风险。在本研究中，我们验证了之前开发的基于 TEG®6S 最大振幅（TEG-MA）的血小板输注计算器在心脏手术中的应用，以最大限度地降低术后出血风险：在这项单中心回顾性研究中，波士顿儿童医院对接受心脏手术、需要心肺旁路的儿童患者（≤18 岁）（N=1000）进行了研究，通过线性回归分析，将根据手术团队决定的血小板输注量与血小板计算器推荐的血小板输注量进行了比较。通过逻辑回归分析评估了围手术期血小板输注量与术后 24 小时内（出血）和出院前（血栓）出血/血栓并发症之间的关系：结果：输血后TEG-MA（≤45mm）测量值较低与术后出血风险较高有关（Odds ratio：4.4；95%CI：2.6,7.4；*p结论：利用定量诊断测试定制围手术期血小板输注疗法有助于减少术后出血并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.