Over the past decade, viscoelastic tests have been increasingly used in different clinical settings. Although there is a growing literature showing advantages of implementing algorithm-based strategies to guide administration of haemostatic agents/products, only limited evidence exists in the paediatric cardiac population.

In this study, Nakayama et al. performed a 2-step trial with the aim of assessing the efficacy of a ROTEM-based algorithm in children undergoing cardiac surgery. In the first part of the study, the authors performed a retrospective analysis and determined ROTEM variables and cutoff values to be used in a transfusion algorithm. Then, the authors randomly assigned 100 children to conventional or algorithm-guided blood product management and assessed the effect on postoperative blood loss and blood product transfusion requirements.

The authors observed that the implementation of an algorithm-based approach significantly reduced postoperative chest tube output drainage (P = 0.002), and the total amount of red blood cells administered (P = 0.02). Although the total amount of fresh frozen plasma (P = 0.87) and platelet concentrate (P = 0.28) did not differ between groups, the use of an algorithm-based approach was associated with a significant difference in the timing of administration. Indeed, children included in the algorithm-based group received haemostatic agents intraoperatively, while children included in the conventional group received more haemostatic agents within the first 24 postoperative hours.

In conclusion, this study confirms that the use of a ROTEM-based transfusion algorithm decreases the amount of postoperative bleeding and allows early treatment of coagulopathy in children undergoing cardiac surgery.

– David Faraoni

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