Anwendungsbeobachtung der ROTEM©-Thrombelastographie in Bezug auf den postoperativen Transfusionsbedarf bei kardiochirurgischen Operationen mit intraoperativem Anschluss an eine Herz-Lungen-Maschine
Observational Application Study of the ROTEM©-Thrombelastography with Respect to the Postoperative Transfusion Requirements in On-Pump Cardiothoracic Surgery
von Christiane Freiin von Saß
Datum der mündl. Prüfung:2017-04-20
Erschienen:2017-04-04
Betreuer:Prof. Dr. Michael Winterhalter
Gutachter:Prof. Dr. Michael Winterhalter
Gutachter:PD Dr. Joachim Riggert
Gutachter:Prof. Dr. Thomas Meyer
Dateien
Name:Christiane von Sass eDISS_bookmarks_optimiert.pdf
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Zusammenfassung
Englisch
ROTEM©-Thrombelastometry as a Point-of-Care method offers real-time evaluation of the plasmatic coagulation. This observational application-study (conducted between 05.08.2009 and 30.10.2009 at the University Clinics Düsseldorf) looked at the development of ROTEM©-indices during on-pump cardiothoracic interventions, whether they have a predictive character concerning post-operative transfusion requirements as well as the existence of a link between them and standard coagulation analyses and the ACT (activated clotting time). In 82 patients we took full blood samples for ROTEM© and standard coagulation analyses at three assigned times: during induction (Time 1), at the end of aortic cross-clamping (Time 2) and after the Application of Protamine (Time 3). Moreover,with the help of the patient's records we established clinical parameters such as Medication, Coagulopathies, Metabolic Disorders, Time of Aortic Cross Clamping, Core Body Temperature, Transfusion Requirements, Laboratory Results and Concentrated Clotting Factor Substitution. In accordance with other studies a clear decrease in the clotting abilities could be noted in ROTEM© and standard Coagulation tests during the time on cardiopulmonary bypass. The ROTEM© -indices show a positive predictive character concerning the application of Factor XIII (Fibrogammin) and Factor VIII / von Willebrandt Factor (Haemate) at the times of sample taking. When combined with standard coagulation tests, 100% predictability could be achieved with respect to the correct assignment into the groups (given/not given). Until now, there are no studies that have reported on this connection. In accordance with other studies, strong correlations could be found between the fibTEM©-MCF and blood-fibrinogen content as well as exTEM© - MCF and the Quick-value. Through linear Regression we generated a formula that can convert fibTEM© - MCF into its corresponding fibrinogen-content in the blood sample (FIBTEM© - MCF = 0,444 + 0,046 x [Fibrinogen]Blood). HepTEM© Values after Aortic Cross Clamping show highly significant correlations with inTEM© values after Protamine had been given. However, hepTEM© tests during full heparinisation do not correctly reflect on the actual inTEM© value after antagonisation with Protamine at a later time. ACT and inTEM© / hepTEM© ratio cannot be converted into one another.
Keywords: Thrombelastography; Transfusion; Point-of-Care; Fibrinogen