• Kimberly C Li, Matthew A Coley, Anthony Chau, Alexander Dotto, Andrew McMillan, Hsian Chiu, and Ronald Ree.
• Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: cheng.li@alumni.ubc.ca.
• J. Cardiothorac. Vasc. Anesth. 2023 Jul 1; 37 (7): 112111281121-1128.

ObjectivesViscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM), are used increasingly in cardiac surgery to guide transfusion decisions. After separation from cardiopulmonary bypass (CPB), achieving hemostasis rapidly is the main goal before chest closure. The authors hypothesized that introducing a ROTEM-guided factor- concentrate transfusion algorithm would reduce the duration from CPB separation to chest closure during cardiac transplantation.DesignA retrospective cohort study of 21 patients before and 28 patients after implementation of the ROTEM-guided transfusion algorithm who underwent cardiac transplantation.SettingThis single-center study was conducted at Saint Paul's Hospital, Vancouver, British Columbia, Canada.InterventionsUsing a ROTEM-guided factor-concentrate transfusion algorithm for cardiac transplant recipients.Measurement And Main ResultsThe primary outcome was the duration from CPB separation to chest closure analyzed using Mann-Whitney U tests. The secondary outcomes included the volume of postoperative chest tube drainage, packed red blood cell (pRBC) transfusion requirements within 24 hours of surgery, the incidence of adverse events, and the length of stay before and after introducing a ROTEM-guided factor-concentrate transfusion algorithm. After adjusting for confounders using multivariate linear regression analysis, using a ROTEM-guided factor-concentrate transfusion algorithm resulted in a significant decrease in time from CPB separation to skin closure of 39.4 minutes (-73.1 to 123.5 min, p = 0.016). For the secondary outcomes, the use of ROTEM-guided transfusion showed reductions in pRBC transfusion within 24 hours of surgery (-1.3 units, -2.7 to 0.1 units; p = 0.077) and chest tube bleeding (-0.44 mL, -0.96 to +0.083 mL; p = 0.097); however, neither was statistically significant after adjustment. The median hospital length of stay in the study group was lower by 3 days (13 days v 16) days; p = 0.048).ConclusionThe introduction of a ROTEM-guided factor-concentrate transfusion algorithm was associated with a significant reduction in time to chest closure after separation from CPB. Although it reduced the total hospital length of stay, there were no differences in mortality, major complications, or intensive care unit length of stay.Copyright © 2023 Elsevier Inc. All rights reserved.

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