Effect of rotational thromboelastometry-guided bleeding management in bilateral lung transplantation

Senned Karrar, Anika Filius, Sanne Langmuur, Edris Mahtab, R.A.S. Hoek, Sanne Hoeks, Merel Hellemons, Maarten ter Horst*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND:

Blood transfusion is often necessary during and after lung transplantation surgery.
Point-of-care guided bleeding strategies, such as rotational thromboelastometry (ROTEM), can reduce
blood transfusion in cardiovascular surgery. This study aimed to assess the effect of ROTEM-guided
bleeding management on the need for allogenic blood transfusion, prohemostatic medication, and
clinical outcomes in lung transplantation patients.

METHODS:

This single-center retrospective cohort study compared patients receiving bilateral lung
transplantation between 2010-2014 and 2017-2020. The first cohort was treated with a clinically
guided bleeding strategy and the second cohort with a ROTEM-guided bleeding strategy. Multivariable
regression analyses were performed to determine the effects on primary outcomes.

RESULTS:

A total of 167 (66 clinically guided vs 101 ROTEM-guided) patients were included for analysis.
Baseline, intraoperative, and postoperative characteristics were mostly similar, but differed regarding the
number of patients with cystic fibrosis, use of cardiopulmonary bypass, and surgical technique. The ROTEM guided group received significantly less median red blood cells (7 [3; 13] vs 4 [1; 9] units, p < 0.01), platelet
concentrate (2 [0; 3] vs 0 [0; 2] units, p = 0.01), and plasma volume (2,310 [1,320; 3,960] vs 800 [0; 1,600]
ml, p < 0.01). In multivariable regression analysis, implementation of the ROTEM strategy only remained
significantly associated with a decreased use of plasma volume. Cardiopulmonary bypass significantly increased allogenic blood transfusion needs. Moreover, more prothrombin complex concentrate, fibrinogen
concentrate, and less tranexamic acid were used in the ROTEM-guided group.

CONCLUSIONS:

ROTEM-guided bleeding management reduces plasma transfusion in bilateral lung
transplant surgery and cardiopulmonary bypass seems to increase transfusion needs.

Original languageEnglish
JournalJournal of Heart and Lung Transplantation
Volume3C
Issue numberFebruary 2024
DOIs
Publication statusPublished - Feb 2024

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