ISSN: 1859 - 2872
Principle, role and application of rotational thromboelastometry (ROTEM) in cardiac surgery with cardiopulmonary bypass
Main Article Content
Keywords
Rotational thromboelastometry, coagulation disorders, cardiac surgery cardiopulmonary bypass
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) is a type of surgery with a high risk of coagulation disorders due to many different causes. To correct coagulation disorders in this surgery, basic coagulation tests were often used, but these tests lacked comprehensiveness in coagulation status and the test time was often too long to guide clinical decisions. Rotational thromboelastometry (ROTEM) is a more comprehensive, fast, and reliable on-site coagulation test, which is more effective in correcting coagulation disorders. This report reviews the principles, roles, and applications of ROTEM to correct coagulation disorders in patients undergoing cardiac surgery with CPB. This will help to better understand the ROTEM test and open a new direction to help the anesthesia and resuscitation process for cardiac surgery with CPB be more effective and comprehensive.
Article Details
References
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2. Korpallová B, Samoš M, Bolek T et al (2018) Role of Thromboelastography and Rotational Thromboelastometry in the Management of Cardiovascular Diseases. Clin Appl Thromb Hemost 24(8): 1199-1207. doi:10.1177/1076029618790092
3. Reardon B, Pasalic L, Favaloro EJ (2024) The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays? J Clin Med 13(12). doi:10.3390/jcm13123612.
4. Drotarova M, Zolkova J, Belakova KM et al (2023) Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics 13(20): 3219.
5. Hartmann J, Hermelin D, Levy JH (2023) Viscoelastic testing: an illustrated review of technology and clinical applications. Res Pract Thromb Haemost 7(1): 100031. doi:10.1016/j.rpth.2022.100031
6. Wells M, Raja M, Rahman S (2022) Point-of-care viscoelastic testing. BJA Educ 22(11): 416-423. doi:10.1016/j.bjae.2022.07.003
7. Nath SS, Pandey CK, Kumar S (2022) Clinical application of viscoelastic point-of-care tests of coagulation-shifting paradigms. Ann Card Anaesth. Jan-Mar 25(1): 1-10. doi:10.4103/aca.aca_319_20
8. Carll T, Wool GD (2020) Basic principles of viscoelastic testing. Transfusion 60(6): 1-9. doi:10.1111/trf.16071
9. Suárez Cuenca J, Gayoso Diz P, Gude Sampedro F, Gómez Zincke JM, Rey Acuña H, Fontanillo Fontanillo MM (2013) Method to calculate the protamine dose necessary for reversal of heparin as a function of activated clotting time in patients undergoing cardiac surgery. J Extra Corpor Technol 45(4): 235-241.
10. Ichikawa J, Kodaka M, Nishiyama K, Hirasaki Y, Ozaki M, Komori M (2014) Reappearance of circulating heparin in whole blood heparin concentration-based management does not correlate with postoperative bleeding after cardiac surgery. J Cardiothorac Vasc Anesth 28(4): 1003-1007. doi:10.1053/j.jvca.2013.10.010.
11. Koster A, Börgermann J, Gummert J, Rudloff M, Zittermann A, Schirmer U (2014) Protamine overdose and its impact on coagulation, bleeding, and transfusions after cardiopulmonary bypass: results of a randomized double-blind controlled pilot study. Clin Appl Thromb Hemost 20(3): 290-295. doi:10.1177/1076029613484085
12. Meesters MI, Veerhoek D, de Lange F et al (2016) Effect of high or low protamine dosing on postoperative bleeding following heparin anticoagulation in cardiac surgery. A randomised clinical trial. Thromb Haemost 116(2): 251-61. doi:10.1160/th16-02-0117
13. Yamamoto T, Wolf HG, Sinzobahamvya N, Asfour B, Hraska V, Schindler E (2015) Prolonged Activated Clotting Time after Protamine Administration Does Not Indicate Residual Heparinization after Cardiopulmonary Bypass in Pediatric Open Heart Surgery. Thorac Cardiovasc Surg 63(5): 397-403. doi:10.1055/s-0035-1554998
14. Karkouti K, Callum J, Crowther MA et al (2013) The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg 117(1): 14-22. doi:10.1213/ANE.0b013e318292efa4
15. Mace H, Lightfoot N, McCluskey S, et al (2016) Validity of Thromboelastometry for Rapid Assessment of Fibrinogen Levels in Heparinized Samples During Cardiac Surgery: A Retrospective, Single-center, Observational Study. J Cardiothorac Vasc Anesth 30(1): 90-95. doi:10.1053/j.jvca.2015.04.030
16. Ranucci M, Baryshnikova E, Crapelli GB, Rahe-Meyer N, Menicanti L, Frigiola A (2015) Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. J Am Heart Assoc. 4(6):e002066. doi:10.1161/jaha.115.002066
17. Ranucci M, Baryshnikova E, Ranucci M, Silvetti S (2017) Fibrinogen levels compensation of thrombocytopenia-induced bleeding following cardiac surgery. Int J Cardiol 249: 96-100. doi:10.1016/j.ijcard.2017.09.157
18. Schultz-Lebahn A, Nissen PH, Pedersen TF, Tang M, Hvas AM (2022) Platelet function assessed by ROTEM(®)platelet in patients receiving antiplatelet therapy during cardiac and vascular surgery. Scand J Clin Lab Invest 82(1): 18-27. doi:10.1080/00365513.2021.2012820
19. Leyra F, Jofre C, Peña N et al (2022) Prediction of platelet counts with ROTEM-sigma in cardiac surgery. Minerva Anestesiol 88(7-8): 573-579. doi:10.23736/s0375-9393.22.15912-2
20. Blasi A, Muñoz G, de Soto I et al (2015) Reliability of thromboelastometry for detecting the safe coagulation threshold in patients taking acenocoumarol after elective heart valve replacement. Thromb Res 136(3): 669-672. doi:10.1016/j.thromres.2015.07.003
21. Schmidt DE, Holmström M, Majeed A, Näslin D, Wallén H, Ågren A (2015) Detection of elevated INR by thromboelastometry and thromboelastography in warfarin treated patients and healthy controls. Thromb Res 135(5): 1007-1011. doi:10.1016/j.thromres.2015.02.022
22. Kallioinen M, Valtonen M, Peltoniemi M et al (2021) Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study. J Perioper Pract 31(9): 326-333. doi:10.1177/1750458920950662
23. Herruzo A, Hinojosa R, Adsuar A, Noval JA, Smani T, Ordoñez A (2021) Clinical impact of rotational thromboelastometry in cardiac surgery. Transfus Clin Biol 28(3): 276-282. doi:10.1016/j.tracli.2021.03.003
24. Naguib AN, Carrillo SA, Corridore M et al (2023) A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery. J Extra Corpor Technol 55(2): 60-69. doi:10.1051/ject/2023017
25. Vallés-Torres J, Gallego-Ligorit L, González-Rodríguez V, et al (2022) Evaluation of the implementation of rotational thromboelastometry guided coagulation management in adult cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 36:12-13. doi:10.1053/j.jvca.2022.09.025
2. Korpallová B, Samoš M, Bolek T et al (2018) Role of Thromboelastography and Rotational Thromboelastometry in the Management of Cardiovascular Diseases. Clin Appl Thromb Hemost 24(8): 1199-1207. doi:10.1177/1076029618790092
3. Reardon B, Pasalic L, Favaloro EJ (2024) The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays? J Clin Med 13(12). doi:10.3390/jcm13123612.
4. Drotarova M, Zolkova J, Belakova KM et al (2023) Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics 13(20): 3219.
5. Hartmann J, Hermelin D, Levy JH (2023) Viscoelastic testing: an illustrated review of technology and clinical applications. Res Pract Thromb Haemost 7(1): 100031. doi:10.1016/j.rpth.2022.100031
6. Wells M, Raja M, Rahman S (2022) Point-of-care viscoelastic testing. BJA Educ 22(11): 416-423. doi:10.1016/j.bjae.2022.07.003
7. Nath SS, Pandey CK, Kumar S (2022) Clinical application of viscoelastic point-of-care tests of coagulation-shifting paradigms. Ann Card Anaesth. Jan-Mar 25(1): 1-10. doi:10.4103/aca.aca_319_20
8. Carll T, Wool GD (2020) Basic principles of viscoelastic testing. Transfusion 60(6): 1-9. doi:10.1111/trf.16071
9. Suárez Cuenca J, Gayoso Diz P, Gude Sampedro F, Gómez Zincke JM, Rey Acuña H, Fontanillo Fontanillo MM (2013) Method to calculate the protamine dose necessary for reversal of heparin as a function of activated clotting time in patients undergoing cardiac surgery. J Extra Corpor Technol 45(4): 235-241.
10. Ichikawa J, Kodaka M, Nishiyama K, Hirasaki Y, Ozaki M, Komori M (2014) Reappearance of circulating heparin in whole blood heparin concentration-based management does not correlate with postoperative bleeding after cardiac surgery. J Cardiothorac Vasc Anesth 28(4): 1003-1007. doi:10.1053/j.jvca.2013.10.010.
11. Koster A, Börgermann J, Gummert J, Rudloff M, Zittermann A, Schirmer U (2014) Protamine overdose and its impact on coagulation, bleeding, and transfusions after cardiopulmonary bypass: results of a randomized double-blind controlled pilot study. Clin Appl Thromb Hemost 20(3): 290-295. doi:10.1177/1076029613484085
12. Meesters MI, Veerhoek D, de Lange F et al (2016) Effect of high or low protamine dosing on postoperative bleeding following heparin anticoagulation in cardiac surgery. A randomised clinical trial. Thromb Haemost 116(2): 251-61. doi:10.1160/th16-02-0117
13. Yamamoto T, Wolf HG, Sinzobahamvya N, Asfour B, Hraska V, Schindler E (2015) Prolonged Activated Clotting Time after Protamine Administration Does Not Indicate Residual Heparinization after Cardiopulmonary Bypass in Pediatric Open Heart Surgery. Thorac Cardiovasc Surg 63(5): 397-403. doi:10.1055/s-0035-1554998
14. Karkouti K, Callum J, Crowther MA et al (2013) The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg 117(1): 14-22. doi:10.1213/ANE.0b013e318292efa4
15. Mace H, Lightfoot N, McCluskey S, et al (2016) Validity of Thromboelastometry for Rapid Assessment of Fibrinogen Levels in Heparinized Samples During Cardiac Surgery: A Retrospective, Single-center, Observational Study. J Cardiothorac Vasc Anesth 30(1): 90-95. doi:10.1053/j.jvca.2015.04.030
16. Ranucci M, Baryshnikova E, Crapelli GB, Rahe-Meyer N, Menicanti L, Frigiola A (2015) Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. J Am Heart Assoc. 4(6):e002066. doi:10.1161/jaha.115.002066
17. Ranucci M, Baryshnikova E, Ranucci M, Silvetti S (2017) Fibrinogen levels compensation of thrombocytopenia-induced bleeding following cardiac surgery. Int J Cardiol 249: 96-100. doi:10.1016/j.ijcard.2017.09.157
18. Schultz-Lebahn A, Nissen PH, Pedersen TF, Tang M, Hvas AM (2022) Platelet function assessed by ROTEM(®)platelet in patients receiving antiplatelet therapy during cardiac and vascular surgery. Scand J Clin Lab Invest 82(1): 18-27. doi:10.1080/00365513.2021.2012820
19. Leyra F, Jofre C, Peña N et al (2022) Prediction of platelet counts with ROTEM-sigma in cardiac surgery. Minerva Anestesiol 88(7-8): 573-579. doi:10.23736/s0375-9393.22.15912-2
20. Blasi A, Muñoz G, de Soto I et al (2015) Reliability of thromboelastometry for detecting the safe coagulation threshold in patients taking acenocoumarol after elective heart valve replacement. Thromb Res 136(3): 669-672. doi:10.1016/j.thromres.2015.07.003
21. Schmidt DE, Holmström M, Majeed A, Näslin D, Wallén H, Ågren A (2015) Detection of elevated INR by thromboelastometry and thromboelastography in warfarin treated patients and healthy controls. Thromb Res 135(5): 1007-1011. doi:10.1016/j.thromres.2015.02.022
22. Kallioinen M, Valtonen M, Peltoniemi M et al (2021) Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study. J Perioper Pract 31(9): 326-333. doi:10.1177/1750458920950662
23. Herruzo A, Hinojosa R, Adsuar A, Noval JA, Smani T, Ordoñez A (2021) Clinical impact of rotational thromboelastometry in cardiac surgery. Transfus Clin Biol 28(3): 276-282. doi:10.1016/j.tracli.2021.03.003
24. Naguib AN, Carrillo SA, Corridore M et al (2023) A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery. J Extra Corpor Technol 55(2): 60-69. doi:10.1051/ject/2023017
25. Vallés-Torres J, Gallego-Ligorit L, González-Rodríguez V, et al (2022) Evaluation of the implementation of rotational thromboelastometry guided coagulation management in adult cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 36:12-13. doi:10.1053/j.jvca.2022.09.025
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Published
Jun 12, 2025
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How to Cite
LâmV. T. (2025). Principle, role and application of rotational thromboelastometry (ROTEM) in cardiac surgery with cardiopulmonary bypass. Tạp Chí Y Dược lâm sàng 108, 20(4). https://doi.org/10.52389/ydls.v20i4.2708