Key result
The implementation of thromboelastometry-guided bleeding management algorithms in pediatric cardiac surgery is associated with a significant reduction in bleeding, transfusion requirements, and mortality.
Thromboelastometry-guided bleeding management and the use of factor concentrates are recommended to optimize hemostasis and reduce transfusion requirements in pediatric cyanotic cardiac surgery.
Limited TEG/ROTEM access outside top centers may constrain point-of-care coagulation management; leaves open equitable implementation strategies in cardiac surgery.
The recommended treatment options for coagulation management during cardiac surgery include fibrinogen concentrate, packed red blood cells, fresh frozen plasma, platelet concentrate (pooled donors or single donor), cryoprecipitate, recombinant factor VIIa, tranexamic acid, epsilon aminocaproic acid, prothrombin complex concentrate, as well as antidotes such as protamine and desmopressin. At present, only the top institutes in the world have TEG and ROTEM testing facilities available for bleeding patients or selected patient populations undergoing major cardiovascular surgery or liver transplantation. TEG and ROTEM should be made available more widely (for all bleeding patients and patients at high risk of bleeding in tertiary hospitals) across India. Inconvenience caused by planning and requesting of blood components and multiple institute-specific hindrances delaying the availability of blood components can be resolved by having factor concentrates available and stored in the operation theater. This approach may reduce transfusion requirements, morbidity, mortality, and healthcare costs.
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Kammerer et al. (2025) conducted a review in Bleeding in pediatric cyanotic cardiac surgery. Thromboelastometry-guided bleeding management algorithms was evaluated. The implementation of thromboelastometry-guided bleeding management algorithms in pediatric cardiac surgery is associated with a significant reduction in bleeding, transfusion requirements, and mortality.
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