BACKGROUND: Thromboelastometric evaluation of coagulation might be useful for prediction and management of @entity548 after paediatric cardiac surgery. We tested the hypothesis that the use of a thromboelastometry-guided algorithm for blood product management reduces @entity190 and transfusion requirements. METHODS: We studied 78 @entity1 undergoing paediatric cardiac surgery with cardiopulmonary bypass (CPB) for the initial 12 h after operation. Stepwise multiple linear regression was used to develop an algorithm to guide blood product transfusions. Thereafter, we randomly assigned 100 @entity1 to conventional or algorithm-guided blood product management, and assessed @entity548 and red cell transfusion requirements. RESULTS: CPB time, post-bypass rotational thromboelastometry (ROTEM(  )) EXTEM amplitude at 10 min (A10), and FIBTEM-A10 were independently associated with chest tube drainage volume during the initial 12 h after operation. Discriminative analysis determined cut-off values of 30 mm for EXTEM-A10 and 5 mm for FIBTEM-A10, and estimated optimal intraoperative fresh-frozen plasma and platelet concentrate transfusion volumes. Thromboelastometry-guided post-bypass blood product management significantly reduced @entity86 (9 vs 16 ml kg(-1), P<0.001) and packed red cell transfusion requirement (11 vs 23 ml kg(-1), P=0.005) at 12 h after surgery, and duration of critical care stay (60 vs 71 h, P=0.014). CONCLUSIONS: Rotational thromboelastometry-guided early haemostatic intervention by rapid intraoperative correction of EXTEM-A10 and FIBTEM- @entity35 reduced @entity190 and red cell transfusion requirements after CPB, and reduced critical care duration in paediatric cardiac surgical @entity1 . CLINICAL TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000006832 (December 4, 2011).

Thromboelastometry-guided intraoperative haemostatic management reduces XXXX and red cell transfusion after paediatric cardiac surgery.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity86 :: ('MESH:D019106', 'Disease') :: ['postoperative bleeding'] @entity35 :: ('10116', 'Species') :: ['A10']
@entity548 :: (MESH:D006470,Disease) :: ['bleeding']
