Abstract 18169: Thromboelastography Predicts Peri-Operative Bleeding Outcomes in Pediatric Patients Undergoing Cardiac Surgery
Introduction: Peri-operative bleeding is the most common morbidity in pediatric patients undergoing cardiac surgery. Although thromboelastography (TEG) has been utilized in select patients, its ability to predict bleeding in this population has not been established.
Hypothesis: We hypothesize that TEG parameters predict bleeding outcomes peri-operatively in pediatric patients undergoing cardiac surgery.
Methods: TEG was performed in 450 pediatric patients undergoing complex cardiac surgery requiring cardiopulmonary bypass (CPB). TEG was performed at baseline (T0), post-protamine in the OR (T1), during the first ICU labs (T2), and 24-hours post-surgery (T3). TEG values from all time points were compared in patients with and without perioperative bleeding. Bleeding was defined by several methods - objective (transfusion requirements, need for re-exploration) or subjective (time spent controlling bleeding in OR, and caregiver assessment).
Results: Although none of the TEG parameters were significantly different between bleeding and non-bleeding patients at the T0, T2, or T3 time points, significantly higher ADP-induced platelet inhibition at T0 was observed in bleeding patients (37.6%) compared to non-bleeding patients (13.5%) (p<0.0001). At T1 time point, abnormal TEG maximum amplitude (MA) was associated with perioperative bleeding. Perioperative bleeding (objective) occurred in 39.4% of patients with abnormal TEG, compared to 27.7% of patients with normal MA (p=0.03). By multivariable regression analysis abnormal TEG MA was independently associated with perioperative bleeding. Patients with abnormal MA who were administered platelet transfusion had lower bleeding in the ICU (12.1%) compared to those without transfusion (21.4%). On the other hand, there was no difference in the bleeding rate in patients with or without platelet transfusion with normal MA.
Conclusions: Inhibition of platelet function pre-surgery may predict peri-operative bleeding. Abnormal TEG MA is associated with perioperative bleeding. Prophylactic platelet transfusion in the OR may not be useful to prevent bleeding in the ICU when patients are not bleeding and with normal MA.
Author Disclosures: S. Emani: None. D. Zurakowski: None. M. Mulone: None. J. DiNardo: None. J. Ibla: None. S.M. Emani: None.
- © 2016 by American Heart Association, Inc.