Comparison Of The Two Types Of Hemostasis Management Effectiveness : Thromboelastometry (Rotem) Guided Management And Conventional Method In Newborn Congenital Cardiac Surgery Patients

Four main scenarios based on clinical observation and ROTEM results were possible: 1. Insignificant bleeding-normal ROTEM; no transfusions 2. Insignificant bleeding-abnormal ROTEM; no transfusions 3. Significant bleeding-normal ROTEM; surgical reevaluation 4. Significant bleeding-abnormal ROTEM; transfusion of blood products as indicated by: 1. FIBTEM A5 \<9 mm -fibrinogen concentrate or cryoprecipitate 2. 9mm ≤ FIBTEM A5 \<13mm and or EXTEM CT \> 80 seconds fibrinogen concentrate or cryoprecipitate and significant bleeding still continued with EXTEM A5 \< 35 mm - platelet concentrate 3. FIBTEM A5 \>13mm and EXTEM A5 \< 35 mm -platelet concentrate 4. After transfusions if the bleeding was still continuing, while surgical reevaluation was in progress, we gave fibrinogen concentrate to replace the lost fibrinogen with the ongoing bleeding. At the same time to verify the treatment effect and control heparin reversal, a second set of INTEM, HEPTEM, EXTEM and FIBTEM analyses were also performed during wound closure. ACT was tested in all patients to control for heparin reversal. If patients had both a pathological ACT and ROTEM (CTIN/ CTHEP ratio ≥ 1,25) protamine was administered first. After fibrinogen and platelet transfusions, if INTEM CT \> 280 seconds and HEPTEM CT \> 280 seconds with continuing bleeding FFP were given. Blood transfusion after paediatric intensive care unit (PCICU) admission was managed without ROTEM guidance by paediatric cardiac surgeons and intensivists.