Comparison of SEER Sonorheometry With Rotational Thromboelastometry and Laboratory Parameters in Cardiac Surgery

BACKGROUND:The Quantra Hemostasis Analyzer is a novel diagnostic device that uses an ultrasound-based technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to characterize the dynamic changes in viscoelastic properties of a blood sample during coagulation. Cardiac surgery utilizing cardiopulmonary bypass (CPB) is associated with a significant impact on the coagulation system and can result in perioperative coagulopathy. The aim of this study was to correlate SEER sonorheometry results to corresponding rotational thromboelastometry (ROTEM) and laboratory parameters obtained before, during, and after CPB. METHODS:The Quantra uses a multiwell cartridge that performs 4 independent measurements with different combination of reagents. The output test results include Clot Time, Clot Stiffness, Fibrinogen and Platelet Contribution, Clot Time Ratio, and Heparinase Clot Time. Clot Time was compared with ROTEM INTEM clotting time and the adjusted partial thromboplastin time. Clot Stiffness was compared with ROTEM EXTEM. The Fibrinogen Contribution to the Clot Stiffness was correlated to ROTEM FIBTEM as well as fibrinogen concentration by the Clauss method. The Platelet Contribution to Clot Stiffness was compared with absolute platelet count and ROTEM-determined clot elasticity attributable to platelets. RESULTS:Fifty-five patients undergoing elective cardiac surgery were enrolled in this prospective observational study. Clot Time exhibited good correlation with ROTEM INTEM clotting time (pre-CPB r = 0.84, post-CPB r = 0.65) and adjusted partial thromboplastin time (pre-CPB r = 0.72, post-CPB r = 0.89); however, the majority of values were within a narrow normal range. Clot Stiffness exhibited significant correlation with ROTEM EXTEM A10 throughout the course of the study in all samples (r = 0.84). Fibrinogen Contribution correlated strongly with FIBTEM A10 (r = 0.85), and moderately with the fibrinogen concentration (r = 0.73) determined with the Clauss assay. The Platelet Contribution to Clot Stiffness showed moderate correlation to absolute platelet counts (r = 0.48). However, the correlation between Platelet Contribution and ROTEM-determined clot elasticity attributable to platelets was stronger (r = 0.78) than platelet number. All of the correlation coefficients were statistically significant with P < .001. CONCLUSIONS:SEER sonorheometry demonstrates significant correlation with ROTEM for determining Clot Stiffness and assessing Fibrinogen Contribution. SEER sonorheometry results can provide valuable information about the coagulation status in patients undergoing cardiac surgery using CPB.

[1]  F. Viola,et al.  A Novel Device for the Evaluation of Hemostatic Function in Critical Care Settings , 2016, Anesthesia and analgesia.

[2]  W. Walker,et al.  Sonic Estimation of Elasticity via Resonance: A New Method of Assessing Hemostasis , 2016, Annals of Biomedical Engineering.

[3]  S. Agarwal,et al.  A comparison of fibrinogen measurement using TEG® functional fibrinogen and Clauss in cardiac surgery patients , 2015, International journal of laboratory hematology.

[4]  H. Schöchl,et al.  Assessing the Methodology for Calculating Platelet Contribution to Clot Strength (Platelet Component) in Thromboelastometry and Thrombelastography , 2015, Anesthesia and analgesia.

[5]  J. Levy,et al.  Point of Care and Factor Concentrate-Based Coagulation Algorithms , 2015, Transfusion Medicine and Hemotherapy.

[6]  B. Romlin,et al.  Platelet count and function in paediatric cardiac surgery: a prospective observational study. , 2014, British journal of anaesthesia.

[7]  J. Amano,et al.  Platelet function during cardiopulmonary bypass using multiple electrode aggregometry: comparison of centrifugal and roller pumps. , 2014, Artificial organs.

[8]  F. Sellke,et al.  Universal definition of perioperative bleeding in adult cardiac surgery. , 2014, The Journal of thoracic and cardiovascular surgery.

[9]  A. Hvas,et al.  Marked changes in platelet count and function following pediatric congenital heart surgery , 2014, Paediatric anaesthesia.

[10]  A. Hanke,et al.  Management of hemorrhage in cardiothoracic surgery. , 2013, Journal of cardiothoracic and vascular anesthesia.

[11]  G. Pelissero,et al.  Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. , 2013, The Annals of thoracic surgery.

[12]  L. Goodnough,et al.  Current Status of Pharmacologic Therapies in Patient Blood Management , 2013, Anesthesia and analgesia.

[13]  F. William Mauldin,et al.  Adaptive force sonorheometry for assessment of whole blood coagulation. , 2010, Clinica chimica acta; international journal of clinical chemistry.

[14]  W. Walker,et al.  A novel ultrasound-based method to evaluate hemostatic function of whole blood. , 2010, Clinica chimica acta; international journal of clinical chemistry.

[15]  T. O’Keeffe,et al.  A massive transfusion protocol to decrease blood component use and costs. , 2008, Archives of surgery.

[16]  C. Eby,et al.  A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery , 2008, Transfusion.

[17]  J. Albes,et al.  Cost reduction of perioperative coagulation management in cardiac surgery: value of "bedside" thrombelastography (ROTEM). , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[18]  A. Brand,et al.  Independent association of massive blood loss with mortality in cardiac surgery , 2005, Transfusion.

[19]  S. McCluskey,et al.  The independent association of massive blood loss with mortality in cardiac surgery , 2004, Transfusion.

[20]  William F. Walker,et al.  Sonorheometry: A Noncontact Method for the Dynamic Assessment of Thrombosis , 2004, Annals of Biomedical Engineering.

[21]  M. Avidan,et al.  Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. , 2004, British journal of anaesthesia.

[22]  G. Nuttall,et al.  Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass , 2001, Anesthesiology.

[23]  D. Royston,et al.  Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass. , 2001, British journal of anaesthesia.

[24]  R. Kekomäki,et al.  On‐site coagulation monitoring does not affect hemostatic outcome after cardiac surgery , 2001, Acta anaesthesiologica Scandinavica.

[25]  M. DePerio,et al.  Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. , 1999, Anesthesia and analgesia.

[26]  B. Coller,et al.  In vitro effects of the platelet glycoprotein IIb/IIIa receptor antagonist c7E3 Fab on the activated clotting time. , 1997, Circulation.

[27]  J L Cox,et al.  Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. , 1996, The Journal of thoracic and cardiovascular surgery.

[28]  B. Spiess,et al.  Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients. , 1995, Journal of cardiothoracic and vascular anesthesia.

[29]  L. Goodnough,et al.  The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery , 1994, Transfusion.

[30]  A. Keats,et al.  Low activated coagulation time during cardiopulmonary bypass does not increase postoperative bleeding. , 1990, The Annals of thoracic surgery.

[31]  J. Apfelbaum.  Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. , 2015, Anesthesiology.

[32]  J. Vincent,et al.  Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery , 2010 .

[33]  Ross Gagliano,et al.  Review of , 2006, UBIQ.

[34]  F. Spencer,et al.  Lack of correlation between activated clotting time and plasma heparin during cardiopulmonary bypass. , 1981, Annals of surgery.