Thromboelastometry-guided coagulation management

Transfusion of packed red blood cells (PRBC), fresh frozen plasma (FFP), cryoprecipitate, and platelet concentrates is strongly associated with increased morbidity and mortality in cardiovascular surgery, patients with myocardial infarction, and critically ill patients [1,2]. This includes transfusion-related acute lung injury, transfusion-associated circulatory overload, ischaemic postoperative morbidity, and sepsis [1]. Furthermore, blood transfusion is associated with prolonged hospital stay as well as increased hospital costs [2]. Based on a five-year experience in point-ofcare (POC) supported coagulation management in liver transplantation [3] we developed and implemented an algorithm including POC supported coagulation management in cardiovascular surgery, based on first line therapy with specific coagulation factor concentrates such as fibrinogen concentrate and prothrombin complex concentrate (PCC) combined with POCthromboelastometry(ROTEM®) and whole blood impedance aggregometry (Multiplate®) [4]. To assess the impact of this approach on transfusion requirements, we compared transfusion rates before and after implementation of this new practice pattern.