Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study.
Minna Kallioinen, Mika Valtonen, Marko Peltoniemi and 5 others
PMID 33427064WHAT IT FOUND
Overall ICU stay and reoperation did not change after ROTEM was introduced, but cardiac surgery patients received less fresh frozen plasma and platelets and more prothrombin complex concentrate.
Key findings
01Fresh frozen plasma use decreased and prothrombin complex concentrate use increased in 2014.
02Postoperative drainage was lower in the 2014 cohort, but mean ICU length of stay did not differ.
03ROTEM was mostly used for severe bleeding, and ROTEM patients received coagulation products more often than matched controls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective before-and-after study, not a randomised trial, so other changes in practice could explain the differences. ROTEM was recorded for only 56 patients in the 2014 cohort, and it was mostly used for severe bleeding, so the ROTEM group was not representative of all cardiac surgery patients. The 2014 cohort had more patients taking clopidogrel and low-molecular-weight heparin, which could affect bleeding and transfusion decisions. The shorter mean ICU stay in the ROTEM group was mainly due to a small number of control patients staying for several days, because the median stay was almost identical. The analysis excluded the highest 2.5% of drainage values and excluded 54 patients for massive drainage, missing values or no pair, so the most bleeding patients were not fully represented.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that ROTEM reduced bleeding for all cardiac surgery patients. The ROTEM group and matched control group had no significant overall drainage difference (1083 ml vs 1333 ml; p = 0.392), and ROTEM was mostly used for severe bleeding.