2018
DOI: 10.1177/0310057x1804600614
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An Audit of the Diagnostic Accuracy of Rotational Thromboelastometry for the Identification of Hypofibrinogenaemia and Thrombocytopenia during Cardiopulmonary Bypass

Abstract: We audited the diagnostic accuracy of ROTEM® (TEM Innovations, GmbH, Munich, Germany) measurements of hypofibrinogenaemia (fibrinogen <1.5 g/l) and thrombocytopenia (platelet count <100 x 10 9 /l) in 200 adult non-transplant patients during cardiopulmonary bypass (CPB). Blood samples were obtained for FIBTEM (assay for the fibrin part of the clot), PLTEM (calculated platelet-specific component), and laboratory measurements simultaneously. Our thresholds for FIBTEM and PLTEM were A10 (clot firmness 10 minutes a… Show more

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Cited by 9 publications
(16 citation statements)
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“…Multiple studies have looked at optimal threshold values of the early FIBTEM parameters A5 and A10 to quickly determine if fibrinogen levels are below a critical point. One study found a similar threshold for A5 as we did (9.5 mm) to determine fibrinogen levels below 1.5 g/L in trauma patients [15], while other studies determined lower threshold levels (5, 6 or 7 mm) [12,20,22,23]. For A10, only one study in patients undergoing cardiac surgery determined the optimal cut-off value, which was similar to ours [24].…”
Section: Discussionsupporting
confidence: 81%
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“…Multiple studies have looked at optimal threshold values of the early FIBTEM parameters A5 and A10 to quickly determine if fibrinogen levels are below a critical point. One study found a similar threshold for A5 as we did (9.5 mm) to determine fibrinogen levels below 1.5 g/L in trauma patients [15], while other studies determined lower threshold levels (5, 6 or 7 mm) [12,20,22,23]. For A10, only one study in patients undergoing cardiac surgery determined the optimal cut-off value, which was similar to ours [24].…”
Section: Discussionsupporting
confidence: 81%
“…In women with postpartum hemorrhage, moderate to good correlations have been found between the Clauss assay and FIBTEM parameters A5, A10 or MCF [10][11][12]. Also in children [13], trauma patients [14][15][16] and patients undergoing liver transplantation [17][18][19] or cardiac surgery [20,21], moderate to good correlations have been found between fibrinogen concentrations and the different FIBTEM parameters. A potential confounder in the patients undergoing cardiac surgery in our study is heparinization, which might have interfered Data are presented as kappa statistics with [95% confidence interval] of the agreement in classification in 3 groups according to fibrinogen level measured by the Clauss assay (low: 1.5; normal: 1.5-3.5 or high: >3.5 g/L) and FIBTEM parameters (low: below normal range, normal: within normal range, high: above normal range).…”
Section: Discussionmentioning
confidence: 99%
“…There was a total of ten studies with diagnostic accuracy data and nine met the eligibility criteria (n ¼ 1820 patients). [51][52][53][54][55][56][57][58][59] The search results are summarised in the PRISMA flow diagram (Figure 1). 43 While this systematic review involved a formal search for studies published only up to 31 December 2018, a subsequent post hoc search by the authors using the same search criteria in the same databases for studies published during 2019 revealed no further diagnostic accuracy studies of viscoelastic POC identification of hypofibrinogenaemia in cardiac surgical patients…”
Section: Search Resultsmentioning
confidence: 99%
“…All were journal articles published between 2012 and 2018. Seven studies were on the ROTEMdelta device, [51][52][53][54][55][56][57] with one study was on the TEG5000 58 and one was on the TEG6S. 59 The reference standard was Clauss fibrinogen in all studies.…”
Section: Details Of Included Studiesmentioning
confidence: 99%
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