Thorac Cardiovasc Surg 2011; 59 - eP58
DOI: 10.1055/s-0030-1269091

Fibrinogen levels during paediatric cardiac surgery measured by conventional laboratory and Fibtem (ROTEM®)

K Martin 1, R Gertler 1, G Balling 2, J Böhm 3, P Tassani-Prell 1, G Wiesner 1
  • 1Deutsches Herzzentrum München, Institut für Anästhesiologie, München, Germany
  • 2Deutsches Herzzentrum München, Klinik für Kinderkardiologie und angeborene Herzfehler, München, Germany
  • 3Deutsches Herzzentrum München, Klinik für Herz- und Gefäßchirurgie, München, Germany

Objectives: Point of care techniques are more and more used for haemostatic management during cardiac surgery. A special focus is fibrinogen as measured with the Fibtem assay by ROTEM®. But data comparing these measurements between infants and newborns throughout surgery are hardly available.

Methods: After approval by the local ethics committee and informed consent 39 patients (19 newborns, 20 infants) scheduled for congenital heart surgery were enrolled. Routine haemostaseological protocol consisted of a balanced blood/plasma extracorporeal circuit priming, ACT controlled heparin management; after discontinuation from bypass modified ultrafiltration was performed. Fibrinogen was measured with conventional laboratory (Clauss method) and Fibtem before surgery (baseline), after heparin reversal (after protamine) and at end of surgery (PICU arrival).

Results:

Table 1: Fibrinogen measurements

Newborns (n=19)

Infants (n=20)

p-value

Baseline

Fibrinogen (mg/dl)

287±146

285±116

0.916

MCF Fibtem (mm)

17±8

14±6

0.233

After protamine

Fibrinogen (mg/dl)

186±69

183±48

0.891

MCF Fibtem (mm)

8±4

8±3

0.478

PICU arrival

Fibrinogen (mg/dl)

239±63

209±34

0.057

MCF Fibtem (mm)

13±6

8±3

0.009

Conclusion: At baseline and after protamine fibrinogen measurements with Clauss-method and Fibtem showed no difference between newborns and infants. At PICU arrival fibrinogen values in newborns were almost recovered, while infant values remained decreased.