2/2/2015 Review of the Nakayama trial

Thromboelastometry-guided intraoperative hemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery.

Y. Nakayama, Y. Nakajima, K. A. Tanaka, D. I. Sessler, S. Maeda, J. Iida, S. Ogawa and T. Mizobe

British J of Anaes. 2014

The study evaluated the effectiveness of a transfusion algorithm guided by ROTEM analysis versus one using the traditional coagulation tests in pediatric cardiac surgery patients. The investigators initially identified the predictors of bleeding after pediatric cardiac surgery from which they developed blood transfusion algorithms. In the subsequent validation phase, 100 patients were randomly assigned to a conventional or a ROTEM guided blood product management . The results showed that the ROTEM guided algorithm led to a reduction in bleeding , RBC transfusions, and duration of stay in the pediatric surgical ICU. This small study was well performed and awaits validation by a larger, multicentre trial. Of interest was the ability for the ROTEM testing to significantly help coagulation management despite being limited to the use of only FFP and platelets and without the benefit of the use of more targeted therapies including cryoprecipitate and other concentrates. This trial adds to the growing body of literature demonstrating the benefit of viscoelastic whole blood testing (ROTEM, TEG) in cardiac surgery. The applicability in the pediatric cardiac surgery population is well demonstrated.

Barbara Steel M.D.
Atrium Medical Center
Middletown Ohio