Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM®-assisted strategy – feasibility and costs.

Patient blood management (PBM) is becoming more and more popular in different clinical settings. Although point-of-care-guided transfusion strategies have been studied in paediatric cardiac surgery, no study has assessed the relationship between the implementation of a perioperative multimodal blood management approach and the incidence of blood product transfusion, outcomes, and costs in the paediatric population.

In this study, Haas et al. performed a retrospective analysis with the aim to compare standard perioperative management based on laboratory analysis and transfusion of fresh frozen plasma (FFP), and PBM based on a ROTEM®-guided algorithm and administration of factor concentrates (fibrinogen, prothrombin complex concentrate and factor XIII). Only 47 children (36 before and 11 after implementation of PBM) were analysed. Despite the absence of FFP transfusion, fibrinogen concentrate was administered in all children analysed after implementation of PBM. In addition, 45% of the children received factor XIII. Mean total costs per patient consisting of transfused allogeneic blood products and factor concentrates were reduced by 17.1% after implementation of the PBM programme.

Although the authors first describe the feasibility and the associated cost reduction of a goal-directed transfusion strategy based on factor concentrates in the paediatric population, these results should be interpreted with caution as neither the ‘optimal’ dose of fibrinogen concentrate nor the safety of fibrinogen supplementation have been studied in the paediatric population. In addition, only sparse data exist regarding factor XIII supplementation and further studies are needed. A significant reduction in costs was observed; however, significant differences in licensing exist between European countries, and therefore the cost reduction should be confirmed in other centres and other countries. Although the authors present promising results, these should be confirmed in further well-powered prospective trials.

– David Faraoni

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