Evaluation of thromboelastometry (Rotem) - guided and conventional hemostasis management effectiveness in neonatal congenital cardiac surgery

IntroductionPost-CPB bleeding remains a critical challenge in neonatal cardiac surgery, and early detection of coagulopathy to guide transfusion decisions may offer significant benefits. We hypothesized that routine use of intraoperative ROTEM as a decision parameter would reduce perioperative transfusions, modulate transfusion patterns and improve the outcomes in newborns undergoing congenital heart surgery.MethodsThis retrospective cohort study was conducted at a single-center tertiary academic hospital and included 58 consecutive neonates who underwent congenital cardiac surgery with cardiopulmonary bypass between April 2022 and October 2023.InterventionsCoagulation parameters before surgery, ACT during surgery and Rotational thromboelastometry (ROTEM) for ROTEM group just before weaning from CPB were evaluated. Transfusion of platelets, fresh frozen plasma, cryopresipitate and fibrinogen concentrate were determined.ComparisonPatients with and without ROTEM-guided transfusion were compared in terms of blood product transfusion.Measurements and Main ResultsIn this study, 58 patients (21 females, 37 males) were analyzed. Preoperatively, hemoglobin and hematocrit levels were significantly higher in the conventional group (<i>p</i> = 0.032, <i>p</i> = 0.033). Postoperatively, the Rotem group had higher hemoglobin, hematocrit, and ACT levels, while platelets were significantly lower (<i>p</i> = 0.0182). Fewer patients in the ROTEM group required transfusions of PRBCs, platelet concentrates, and cryoprecipitate (<i>p</i> < 0.05). Additionally, the Rotem group had significantly lower median intraoperative cryoprecipitate and platelet concentrates use compared to the conventional group (<i>p</i> < 0.001).ConclusionROTEM analyses before discontinuation of CPB facilitate hemostasis management and reduce the use of allogenic blood products during neonatal cardiac surgery and the immediate postoperative period.