Thromboelastographic evaluation after cardiac surgery optimizes transfusion requirements in the intensive care unit: a single-center retrospective cohort study using an inverse probability weighting method

Abstract

Objective There are no reports from Japan showing the effects of using the thromboelastography algorithm on transfusion requirements after Intensive Care Unit (ICU) admission, and post-implementation knowledge regarding the thromboelastography algorithm under the Japanese healthcare system is insufficient. Therefore, this study aimed to clarify the effect of the TEG6s thromboelastography algorithm on transfusion requirements for patients in the ICU after cardiac surgery. Methods We retrospectively compared the requirements for blood transfusion up to 24 h after ICU admission using the thromboelastography algorithm (January 2021 to April 2022) (thromboelastography group; n = 201) and specialist consultation with surgeons and anesthesiologists (January 2018 to December 2020) (non-thromboelastography group; n = 494). Results There were no significant between-group differences in terms of age, height, weight, body mass index, operative procedure, duration of surgery or cardiopulmonary bypass, body temperature, or urine volume during surgical intervention. Moreover, there was no significant between-group difference in the amount of drainage at 24 h after ICU admission. However, crystalloid and urine volumes were significantly higher in the thromboelastography group than in the non-thromboelastography group. Additionally, fresh-frozen plasma (FFP) transfusion volumes were significantly lower in the thromboelastography group. However, there were no significant between-group differences in red blood cell count or platelet transfusion volume. After variable adjustment, the amount of FFP used from the operating room to 24 h after ICU admission was significantly reduced in the thromboelastography group. Conclusions The thromboelastography algorithm optimized transfusion requirements at 24 h after admission to the ICU following cardiac surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s11748-023-01941-8.

Use of Thromboelastography in Coronary Artery Bypass Grafting in a Patient With Factor Ⅴ Deficiency With Platelet Function Disorders: A Case Report and Literature Review

“…As part of the perioperative management for patients undergoing cardiac surgery using CPB, our hospital uses a protocol for measuring TEG after weaning from CPB and admission to the intensive care unit to determine whether transfusion should be performed to ensure appropriate management [ 6 ]. Although the reaction time (R) result was just below the prescribed limit (CKH-R<10 mm) in TEG measurement after protamine administration, the anesthesiologists and cardiac surgeons determined the use of cryoprecipitate considering the total amount as the patient had FⅤ deficiency and was undergoing dialysis.…”

“…Red blood cell concentrates were transfused to maintain a hemoglobin level over 7-8 g/dL during CPB. The TEG®6s (Hemonetics LLC, Tokyo, Japan) algorithm (Figure 1 ) is used in operating rooms and intensive care units at our hospital to determine the required transfusion formulation [ 6 ].…”