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DOI: 10.1055/s-0030-1269091
Fibrinogen levels during paediatric cardiac surgery measured by conventional laboratory and Fibtem (ROTEM®)
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:
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.