HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andreas Straub Hans Peter Wendel Carole Hamilton Gerhard Ziemer Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Straub, A. Articles by Ziemer, G. Search for Related Content PubMed Articles by Straub, A. Articles by Ziemer, G. Related Collections Extracorporeal circulation

Using reagent-supported thromboelastometry (ROTEM^®) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest

^a Department of Thoracic, Cardiac and Vascular Surgery, University of Tübingen, Germany
^b Department of Anaesthesiology and Intensive Care Medicine, University of Tübingen, Germany
^c Department of Medical Biometry, University of Tübingen, Germany

Received 20 September 2007; received in revised form 2 May 2008; accepted 21 May 2008.

^_* Corresponding author. Address: Baker Heart Research Institute, Centre for Thrombosis & Myocardial Infarction, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia. Tel.: +61 3 8532 1490 fax: +61 3 8532 1160. (Email: Andreas.Straub{at}baker.edu.au).

Objective: Cardiac surgery employing cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) can induce coagulation disturbances and bleeding complications that may be especially severe in infants. A better understanding of the coagulopathy and a quick method for its evaluation would be helpful in the management of patients exposed to CPB and DHCA. This study aimed to monitor coagulation defects in congenital heart surgery using rotational thromboelastometry (ROTEM^®), standard coagulation tests and platelet flow cytometry. Methods: The study comprised 10 infants undergoing surgery for congenital heart disease on CPB and DHCA. Blood was sampled at skin incision, after heparinisation during CPB (directly pre- and directly post-DHCA) and after protamine administration post-CPB. ROTEM^® using different reagents including a heparinase-containing assay to evaluate coagulation during heparinisation, APTT and INR, and flow cytometry to evaluate platelet activation were performed. Results: During CPB, the ROTEM^® indicated CPB-induced clotting factor depletion and platelet dysfunction that persisted after CPB and heparin neutralisation. ROTEM^® results were available within 15 min and therefore much faster than standard tests. ROTEM^®-guided specific blood product treatment resulted in satisfactory coagulatory function. The highest degree of platelet activation was found directly after DHCA. Conclusions: A major benefit of ROTEM^® is the quick detection of a developing coagulopathy already during CPB. ROTEM^® guides quick and specific blood product treatment after CPB, which may decrease bleeding complications in cardiac surgery. The finding of maximal platelet activation directly after DHCA suggests that not only CPB but also hypothermia activates platelets in vivo, thereby contributing to platelet dysfunction.

Key Words: Cardiopulmonary bypass • Deep hypothermic circulatory arrest • Haemostasis • Thromboelastometry • Congenital cardiac surgery