Thrombelastometry guided blood-component therapy after cardiac surgery: a randomized study

BMC Anesthesiology

Table 1 Transfusion protocol for the ROTEM®-guided group

Trigger:	drainage loss > 200 ml / h or 100 ml / 30 min at 30 min after arrival at the ICU
1.	4-chamber TEM (1 INTEM, 2 HEPTEM, 3 FIBTEM, 4 APTEM), Quick, AT3
2.	CT-INTEM/CT-HEPTEM> 1.5 = > 5000 IE Protamin
3.	CT-HEPTEM> 260 s = > FFP units (kg body weight)^a
4.	a: MCF-HEPTEM 35–45 mm and MCF-FIBTEM > 8 mm = > 1 platelet concentrate b: MCF-HEPTEM< 35 mm = > 1 platelet concentrate
5.	MCF-FIBTEM < 8 mm = > 2 g Fibrinogen
6.	MCF-APTEM/MCF-HEPTEM > 1.5 or Aprotinin effective optically = > 2 Mio IE Aprotinin / 2 g Tranexamic acid
	• In case of persistent bleeding - > re-testing according to (1) and further therapy as suggested by the protocol. • 2000 IE PPSB if INR > 2.0 and known liver dysfunction or previous Coumadin therapy. • 2000 IE AT3 if an increase > 50% (prothrombin time) is not to be expected via FFP-substitution.

Transfusion of RBCs according to the haemoglobin level of the blood-gas-analysis. Target value > 8.0 g/dl
^aFFP (15 ml / kg KG): < 58 kg body weight - > 3 FFP, 58–75 kg body weight - > 4 FFP, 75–92 kg body weight - > 5 FFP, > 92 kg body weight - > 6 FFP
The entries in boldface represent the administered blood-components

ISSN: 1471-2253