28 de agosto de 2012

Artigo recomendado: Does Rotational Thromboelastometry (ROTEM) Improve Prediction of Bleeding After Cardiac Surgery?

Lee GC et al. – The results suggest that Rotational thromboelastometry (ROTEM) data do not substantially improve a model's ability to predict chest tube drainage, beyond frequently used clinical and laboratory parameters. Although several ROTEM parameters were individually associated with chest tube output (CTO), they did not significantly improve goodness of fit when added to statistical models comprising only clinical and routine laboratory parameters. ROTEM does not seem to improve prediction of chest tube drainage after cardiac surgery involving CPB, although its use in guiding transfusion during cardiac surgery remains to be determined.

Anesthesia & Analgesia, 08/22/2012  Clinical Article

Methods
  • Three hundred twenty-one patients undergoing cardiac surgery involving CPB were enrolled.
  • Patient data were obtained from medical records, including chest tube output (CTO) from post-CPB through the first 8 postoperative hours.
  • Perioperative and postoperative blood samples were collected for ROTEM analysis.
  • Three measures of CTO were used as the primary end points for assessing coagulopathy: continuous CTO; CTO dichotomized at 600mL (75th percentile); and CTO dichotomized at 910mL (90th percentile).
  • Clinical and hematological variables, excluding ROTEM data, that were significantly correlated (P < 0.05) with continuous CTO were included in a stepwise regression model (model 1).
  • An additional model that contained ROTEM variables in addition to the variables from model 1 was created (model 2).
  • Significance in subsequent analyses was declared at P < 0.0167 to account for the 3 CTO end points.
  • Net reclassification index was used to assess overall value of ROTEM data.

Results
  • For continuous CTO, ROTEM variables improved the model's predictive ability (P < 0.0001).
  • For CTO dichotomized at 600mL (75th percentile), ROTEM did not improve the area under the receiver operating characteristic curve (AUC) (P = 0.03).
  • Similarly, for CTO dichotomized at 910mL (90th percentile), ROTEM did not improve the AUC (P = 0.23).
  • Net reclassification index similarly indicated that ROTEM results did not improve overall classification of patients (P = 0.12 for CTO ≥ 600mL; P=0.08 for CTO ≥ 910mL).

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