Eric Mendeloff1, George Glenn1, Paul Tavakolian2, Eugene Lin2, Allison E. Leonard2, Syma L. Prince2, John Kampine1, Morley A. Herbert1; 1Medical City Children's Hospital, Dallas, TX; 2CRSTI, Dallas, TX
Objective: Thromboelastography (TEG) measures the dynamics of clot formation in whole blood. TEG data can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants undergoing open-heart surgery.Methods: Values measured include R (time to fibrin formation), Angle (fibrinogen formation) and MA (platelet function). Increased R times indicate loss of enzymatic factors and a need for fresh frozen plasma (FFP), a decreased angle determines the need for cryoprecipitate (Cryo), and a drop in MA reflects need for platelets (Plts). Blood product usage, TEG values, and operative parameters were collected prospectively on 75 infants (38 acyanotic) undergoing open-heart surgery within the first 6 months of life. Controls consisted of chart data on 67 patients (38 acyanotic) undergoing the same surgical procedures prior to implementation of TEG (pre-TEG).
Results: Implementation of TEG resulted in a change in the pattern of blood product utilization. Significantly more intra-op packed red blood cells (PRBC) and FFP were administered in the TEG group. In the postop interval TEG patients had a strong trend toward decreased FFP usage and a significant decrease in volume of PRBC, Plts, and overall CT output. TEG resulted in no differences in Cryo usage. Using TEG data, we examined the effects of cyanosis on clot formation. During cardiopulmonary bypass (CPB) the platelet function (MA) dropped similar amounts in acyanotics and cyanotics 31 ± 12% vs 33 ± 19% (p=0.66), but following heparin reversal, cyanotic patients show greater recovery in MA, 9 ± 36% vs 31 ± 37% (p =0.06). Cyanotic patients tend to be more sensitive to clotting factor dilution during CPB as indicated by an R of 86 ± 162% as compared to 50 ± 69% (p=0.34) in acyanotics.
Conclusion: TEG allows for proactive, directed blood component therapy with improved clotting status in infants undergoing CPB. This results in decreased blood loss and blood product administration post-op.
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