Which factors have a great impact on coagulopathy and hemostatic impairment after cardiopulmonary bypass in cardiovascular surgery? An analysis based on rotational thromboelastometry,General Thoracic and Cardiovascular Surgery

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Which factors have a great impact on coagulopathy and hemostatic impairment after cardiopulmonary bypass in cardiovascular surgery? An analysis based on rotational thromboelastometry
General Thoracic and Cardiovascular Surgery ( IF 1.2 ) Pub Date : 2021-08-13 , DOI: 10.1007/s11748-021-01688-0
Kenshi Yoshimura ₁ , Hirotsugu Hamamoto ₂ , Takafumi Abe ₂ , Norio Itai ₂ , Shuichiro Uehara ₂ , Takuya Tsusue ₂ , Satomi Tahara ₃ , Hideo Iwasaka ₃ , Hiroki Sato ₄ , Shinji Miyamoto ₁

Affiliation

Objectives

This study aimed to investigate which factors have a great impact on coagulopathy after cardiopulmonary bypass (CPB) using rotational thromboelastometry (ROTEM).

Methods

Ninety-eight patients undergoing cardiovascular surgery using CPB were enrolled. Data of amplitude 10 min after clotting time (A10) of ROTEM measured routinely before and after CPB were retrospectively collected. ROTEM has some assays by which we can evaluate the capacity of extrinsic coagulation (EXTEM), intrinsic coagulation (INTEM), fibrin polymerization (FIBTEM), and the effect of heparin (HEPTEM). The platelet component, defined as PLTEM, can be calculated by subtracting FIBTEM from EXTEM. Age, sex, total plasma volume, pre-CPB A10, lowest body temperature, in–out balance during CPB, intraoperative bleeding amount, and type of pumps were considered as possible factors. Univariate and multivariate analyses were performed for the rate of change of A10.

Results

The change rate of each A10 had a significant negative correlation with bleeding amount (p < 0.01 for EXTEM, p < 0.01 for INTEM, p = 0.02 for FIBTEM, p < 0.01 for PLTEM). Female sex was a significant contributive predictor for the greater decline of EXTEM (p < 0.01) and INTEM (p < 0.01), positive balance for EXTEM (p < 0.01), FIBTEM (p = 0.01), and PLTEM (p < 0.01), long CPB time for INTEM (p = 0.01), centrifugal pump for FIBTEM (p < 0.01), and large pre-CPB A10 for PLTEM (p < 0.01).

Conclusion

In perioperative hemostatic management using ROTEM, attention should be given to the effects of these multiple factors.

中文翻译：

哪些因素对心血管手术体外循环后凝血功能障碍和止血障碍影响较大？基于旋转血栓弹力图的分析

目标

本研究旨在使用旋转血栓弹力图 (ROTEM) 调查哪些因素对体外循环 (CPB) 后的凝血功能障碍有很大影响。

方法

招募了 98 名使用 CPB 进行心血管手术的患者。回顾性收集CPB前后常规测量的ROTEM凝血时间后10 min振幅数据（A10）。ROTEM 有一些检测方法，我们可以通过这些检测方法评估外在凝血 (EXTEM)、内在凝血 (INTEM)、纤维蛋白聚合 (FIBTEM) 和肝素 (HEPTEM) 的作用的能力。血小板成分，定义为 PLTEM，可以通过从 EXTEM 中减去 FIBTEM 来计算。年龄、性别、总血浆量、CPB前A10、最低体温、CPB期间的出入平衡、术中出血量和泵类型被认为是可能的因素。对 A10 的变化率进行了单变量和多变量分析。

结果

每个A10的变化率与出血量呈显着负相关（ EXTEM p < 0.01，INTEM p < 0.01，FIBTEM p = 0.02，PLTEM p < 0.01）。女性是 EXTEM ( p < 0.01) 和 INTEM ( p < 0.01) 下降幅度更大的重要预测因子， EXTEM ( p < 0.01)、FIBTEM ( p = 0.01) 和PLTEM ( p < 0.01) 呈正平衡, INTEM 的 CPB 时间长 ( p = 0.01), FIBTEM 的离心泵 ( p < 0.01), PLTEM 的大型 pre-CPB A10 ( p < 0.01)。