Change in Hemostatic Intervention After Implementation of Thromboelastometry

ObjectiveTo monitor the use of blood products and hemostatic intervention after implementation of thromboelastometry.DesignObservational prospective study using a historic control.SettingSingle-center university hospital.ParticipantsPatients undergoing cardiac surgery during 2008 (n = 811) were compared with similar patients in 2009 (n = 865).InterventionsThromboelastometry was implemented in December 2008. Changes in transfusion of blood products and changes in use of recombinant factor VIIa and fibrinogen were studied.Measurements and Main ResultsUse of blood products was not decreased significantly after implementation of thromboelastometry. However, in patients receiving blood products, the units of red blood cells were decreased significantly (p = 0.04). Regarding hemostatic reagents, the use of recombinant factor VIIa was decreased significantly (p = 0.04), and the use of fibrinogen increased significantly (p < 0.001). Most blood products (>70%) were given to a minority of patients (∼10%) in 2008 and 2009. In 2009, thromboelastometry was performed in 146 patients (17%), and the use of blood products (p < 0.0001), recombinant factor VIIa (p < 0.001), and fibrinogen (p < 0.001) was significantly higher compared with patients in whom thromboelastometry was not performed.ConclusionsAfter implementation of thromboelastometry, the use of recombinant factor VIIa was decreased significantly, whereas the use of blood products was not decreased significantly in patients undergoing cardiac surgery.