Intraoperative Ultrasound-Based Assessment of Coagulation in Cardiac Surgery Patients: A Single-Center Experience

Background: Bleeding after cardiac surgery is common. Intraoperative assessment of whole blood coagulation may allow early targeted treatment of coagulopathy associated with cardiopulmonary bypass. The performance of an ultrasound-mediated method of whole blood coagulation testing is assessed and compared with guidance by routine laboratory testing.

Methods: A retrospective single-center experience of 1077 patients is reported comparing transfusion practices with and without viscoelastic testing in two consecutive years with no other changes in clinical practice. The primary end point was the incidence and volume of transfusion of packed red cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate. Secondary endpoints included hospital mortality, re-exploration for bleeding, stroke, new onset renal failure, and prolonged ventilation.

Results: There was no difference in the incidence of patients needing transfusion, but there was a significant drop in the volume of products given with the adoption of whole-blood testing. The decline in FFP and cryoprecipitate reached statistical significance. Although there was not a statistically significant decline in red cell administration, patients tolerated targeted nonred cell administration with less postoperative anemia. There were no other changes in clinical outcomes.

Conclusion: Intraoperative ultrasound-mediated whole blood coagulation testing resulted in a substantial decline in nonred cell blood product administration in cardiac surgery patients.