• KuiperGerhardus J A J MGJAJMDepartment of Anaesthesiology and Pain Treatment, Maastricht University Medical Center, Maastricht, the Netherlands; Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research I, Lieve T van Egmond, HenskensYvonne M CYMCCentral Diagnostic Laboratory, Cluster for Haemostasis and Transfusion, Maastricht University Medical Center, Maastricht, the Netherlands., Paul M Roekaerts, Jos G Maessen, Ten CateHugoHDepartment of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht , Wolfgang F Buhre, and Marcus D Lancé.
• Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Center, Maastricht, the Netherlands; Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address: gerhardus.kuiper@one-mail.on.ca.
• J. Cardiothorac. Vasc. Anesth. 2019 Feb 1; 33 (2): 307-317.

ObjectivesRotational thromboelastometry (ROTEM)-guided transfusion algorithms in cardiac surgery have been proven to be successful in reducing blood loss in randomized controlled trials. Using an institutional hemostasis registry of patients in cardiac surgery (HEROES-CS), the authors hypothesized that the use of ROTEM-guided transfusion algorithms would save blood products and overall costs in cardiac surgery in every day practice.DesignObservational, prospective open cohort database.SettingSingle-center academic hospital.ParticipantsCardiac surgery patients.InterventionsImplementation of ROTEM-guided bleeding management.Measurements And Main ResultsA classical-guided algorithm and a ROTEM-guided algorithm were used for patient blood management in 2 cohorts. Primary outcome was the use and amount of blood products and hemostatic medication. Secondary outcomes were amount of rethoracotomies, length of stay, and 30-day mortality. Finally, costs and savings were calculated. The classical-guided cohort comprised 204 patients, and ROTEM-guided cohort comprised 151 patients. Baseline characteristics showed excellent similarities after propensity score matching of 202 patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p = 0.582). More tranexamic acid was given, but not more fibrinogen concentrate, while desmopressin was given less often. Hospital length of stay was reduced by an overall median of 2 and a mean of 4 days (p < 0.001). Mortality and rethoracotomy rates were not affected. Potential savings were about €4,800 ($5,630) per patient.ConclusionsImplementation of a ROTEM-guided transfusion algorithm in cardiac surgery patients reduced the use of blood products and hemostatic medication, hereby saving costs. Reductions in mortality and rethoracotomy rates could not be found.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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